Pregnancy and the postpartum period involve several physiological adaptations crucial for offspring care. Recent research has highlighted reproduction-related brain plasticity in human mothers. Associations with aspects of maternal caregiving suggest adaptive changes that facilitate a woman’s transition to motherhood. However, the dynamic changes that affect a woman’s brain are not merely adaptive, and they likely confer a vulnerability for the mental disorders. To elucidate the pathophysiology of psychiatric problems that occur during the perinatal period, gaining insights into the physiological changes in brain function due to pregnancy is crucial.

Although it has been hypothesized that pregnancy enhances social cognitive functions in mothers to adapt to the offspring care, there are few reports to support this hypothesis. This study aims to investigate whether social cognitive functions change during the first pregnancy, with a focus on maternal adaptation to offspring care.

The study included a first pregnancy group and a never-pregnant control group. We conducted a prospective study comparing pregnant women between two-time points (T1, T2); at less than 21 weeks of gestation [T1] and those after 30 weeks of gestation [T2]. To assess the effects of pregnancy and gestational age (< 21 weeks or 30 weeks or more), both the control (never-pregnant) group and pregnant group were evaluated at two time points with similar intervals. The Emotion Recognition Task [ERT] of the Cambridge Neuropsychological Test Automated Battery (CANTAB) was performed to examine the emotion recognition of six basic emotions in facial expressions. We analyzed a cohort of 26 participants in the pregnant group and 25 in the control group. We performed a two-way repeated measures analysis of variance with pregnancy status and gestational period (T1, T2) as independent variables.

Significant interactions between group and time points (T1, T2) were observed only for Unbiased Hit Rate Anger (p<0.01); facial recognition accuracy for anger increased with the progression of pregnancy. There were no significant interactions for Unbiased Hit Rate Sadness, Happiness, Fear, Disgust, or Surprise.

This is the first study to demonstrate that facial recognition of anger enhances with the progression of pregnancy, utilizing never-pregnant women as a never-pregnant control group. The results of this study contribute to the physiological effects of pregnancy on the brain and cognitive function and have potential for further study of perinatal mental health problems.

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Promoting high quality mental health (MS) services is an obligation of many social agents due to the impact of these diseases on the population. Making care increasingly evidence-based does not depend exclusively on technical training, but also on gradual and functional changes in the structure of an institution. Improving the quality of services in MH is a predominantly social intervention, in which it is necessary to group and interpret complex data. They represent real-time interventions in a real world by teams delivering health services.

Describe the context where the MH service (iNC) is inserted, its main characteristics and purposes.

Mixed study identifying the location, socio-demographic data, characteristics and fundamentals of an organization providing services in MH that proposes to act based on evidence.

iNC is a private secondary care institution located in the city of Blumenau, Vale do Itajaí, state of Santa Catarina, Brazil (FIG 1). Vale do Itajaí is a mesoregion with approximately 1.5 million inhabitants composed of small regions: Blumenau, Itajaí Ituporanga and Rio do Sul. Most of the population is of German and Italian descent. Blumenau has 361,261 inhabitants, an average monthly income of 2.9 minimum wages, 97% of schooling between 6-14 years old and the number of deaths of 6.48 (1000 live births). iNC is located in the center of the city (3-story building) with a clinical staff idealized for 3 psychiatrists, 16 psychologists, 4 nutritionists, 1 nurse, 1 nursing technician and 1 physical educator in face-to-face and online, individual and in-person sessions group. Performs care for adult patients between 18-70 years. Its missions are: to promote MS care from an interdisciplinary perspective, to provide health interventions supported by the best individualized scientific evidence and to encourage teaching and research in the field of MH. Its guiding principles are: psychopathology and nosology (DSM-5 and CID-11), neuroscience and psychopharmacology, mood, anxiety, sleep, eating and obesity disorders (FIG 2), psychological treatments and psychoeducation, assessment instruments in MH and neuropsychology, evidence-based medicine, health promotion and disease prevention.

Identifying, measuring and quantifying a local assistance service in MH can help in its development and allow comparisons over time. The improvement of services depends on multiple factors and is necessary for their development, both for researchers, implementers, health professionals and patients.

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The Watersports Inclusion Games is a free annual weekend event, where young people with a range of physical and intellectual disabilities and their families/siblings participate in various inclusive watersports activities.

This study aims to assess the psychological benefits of watersports for young people with various physical and intellectual disabilities and investigate the extent of the impact of the COVID-19 pandemic on their access to watersports.

Following a literature review, a survey containing both quantitative and qualitative aspects was constructed using SurveyMonkey and circulated to the parents/guardians of participants three times following the event. The survey was completed anonymously on an opt-in basis and 28 responses that met our criteria for analysis were collected. Qualitative data from free-text responses were grouped under themes and quantitative data was analysed using SPSS.

Despite 64% (n=18) of respondents indicating that their disability increased their vulnerability to COVID-19 in some capacity, the effect of the pandemic on accessibility was not statistically significant. This could be due to the small response number, or the everyday limitations participants faced prior to the pandemic. 92% (n=25) of participants indicated that there was great inclusion in the watersports activities and that they were “very beneficial” regarding the possibility of the whole family’s participation [p=0.005]. The survey also found a statistically significant association between the event’s activities being considered both “accessible” and “very beneficial” in terms of boosting self-confidence, with 57.1% of responses indicating agreement to this. (p=0.016)

Full-family participation and accessibility of activities were key facilitators to the enjoyment and benefit of participants. Programmes should be established that allow able-bodied siblings and young people with disabilities to participate in the same activities.

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Ethnicity and migration have an impact on illness models and consequently how, when and where people seek and obtain care. Early Intervention Psychosis (EIP) teams attend high rates of migrant and ethnic diverse populations but the study of ethnic differences in pathways to obtain and maintain care is still scarce . The most consistent findings are that minorities are less involved with primary services, have a higher risk of being treated in a coercive way and are at higher risk of early disengagement. Despite the increasing migration rates there has been very little investigation in Spain.

To investigate ethno-racial differences in pathways to obtain care, adherence and engagement during their first year of follow-up of subjects who start treatment at EIP of Reus, Catalonia, Spain

Participants

This is an observational 12 months follow-up retrospective study including all consecutively subjects with First Episode of Psychosis (FEP) referred to the EIP from January 2015 to January 2019. Visible ethno-racial status was self-reported being grouped as belonging to minority ethno-racial group if they were coded “any other than White regardless of country of origin”. ‘White’ was the majority group

Study variables:

At program entry:

Source of referral

At 12- months:

Adherence to the service:

Admissions to in-patient unit

Disengagement

184 FEP subjects (mean age 22.8 years and 66.1% of males) were included. Nearly 31% belonged to a minority ethno-racial group being the Maghrebi (60.4%) followed by the Latin-American (20.1%) the most frequent minority groups. The 81.2% of the minority group were first-generation migrants and 7.5% second generation migrants. The 52.2 % were referred from community services, 18.5% from emergency unit and 29.3% from inpatient unit. At follow up 64.5%, were highly adherent to EIP (> 75% of attended appointments), 16.7% required hospitalization and 11% disengaged. Multivariate analysis showed that the minority group was 2.19 times more likely to be low adherent [(95% CI 0.78-3.17; p=0.03], 2.89 times more likely to be hospitalised [(95% CI 1.20-6.98); p=0.01], and 4 times more likely to disengage from the EIP [(95% CI 1.35-11.90); p= 0.01] during follow-up than the majority group. No group differences were found in pathways to obtain care or in causes of disengagement.

In agreement with previous studies from other countries we found high rates of ethno-racial diversity in the EIP of Reus. In addition, we also found inequalities in the use of services, being minorities more likely to disengage, to be low adherent to the program and at greater risk of hospitalization. On contrary to other studies we did not find significant differences between groups in the source of referral to EIP

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UK healthcare is undergoing significant challenges in facing borderline personality disorder (BPD) and accommodating the increased demand to allocate sufficient care and carers to deal with BPD’s growing number and emotional and suicidal crises.

To generate forecasting models and preventive policies to deal with BPD crises and improve the effectiveness of the UK National Healthcare Service in suicide prevention (NHS).

The underlying analysis framework is stochastic forecasting. We used current knowledge and data to complete systematic future predictions extracted from recent trends. A logical-mathematical model generated the required expressions. The software for logic prediction and annotation was Wolfram Alpha (Wolframalpha.com).

Persons with BPD become suicidal because the team cannot comprehend and address the cycle of dysthymia, rumination and suicide. The BPD crises start from Stage 1 (α), assessing the comorbidity between BPD with dysthymia, cyclothymia, autism and ADHD. Teams shall avoid overmedication as ineffective. Stage 2 (β) is introspection and rumination, which do not respond to pharmacotherapy. The health carers establish if rumination is present and suggest distraction techniques. Stage 3 (γ) is when constant rumination with catastrophising leads to hopelessness. Stage 4 (δ) is when BPD starts feeling more anxious, depressed and unable to stop rumination. We suggest thought-stopping techniques and discourage social isolation, which triggers rumination. As BPDs use external locus of control and aim for higher dosages of antidepressants and anxiolytics with minimal effect, we explain that medication is not the only solution. Stage 5 (ε) is a crisis and panic attack because constant rumination brings back traumatic thoughts focused on the past, present and future. This is when BPDs self-refer to the hospital, attempt suicide, and feel that hospital admission is the only solution. The stages combined generated Model I. The Model II forecast Δ from this study is that we will observe a higher frequency (Δ) of hospital occupancy (Δbo = A), suicidal attempts (Δsa = B), and heavy service use (Δsu = C) by BPDs.

The predictive model algorithm has thus extracted (1) Model I (Analysis): [α → (β → (γ → (δ → ε)))] = Z; The truth density for Model I and its strength of prediction for stage progression is 96.87% in the dysthymia-rumination-suicide cycle; and (2) Model II (Prediction): Z implies (A And B And C), Z→A ∩ B ∩ C; the truth density for the Model II is 56.25% for predicting a national shortage of healthcare resources. The combined models predict a truth of 73.81% in the outcomes of BPD crises in the UK NHS due to the dysthymia-suicide cycle.

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Incarcerated individuals are subject to a heightened risk of both mental and physical ailments. Hence, it is important to conduct regular assessments of their mental well-being and other potential health hazards.

The aim of this study is to examine the subjective experience of fear related to COVID-19 and the psychological consequences of the pandemic among a cohort of young adult male convicts.

A research design using an institutional-based quantitative cross-sectional approach was used. The data collecting period was from July to September 2022, during which data was gathered at a juvenile correctional facility located in the center area of Portugal. The researchers used questionnaires to gather data pertaining to demographic and health attributes, fear related to COVID-19, as well as measures of depression, anxiety, stress, and resilient coping.

The study included a cohort of 60 incarcerated males who had been imprisoned for a duration exceeding 2 years. The prevalence of stress was found to be the highest among offenders, with around 75% reporting this symptom. Anxiety was the second most often reported symptom, with 38.3% of inmates experiencing it, followed closely by depression, which was reported by 36.7% of the inmate population. The average score on the Fear of COVID-19 Scale was 17.38 ± 4.80, suggesting that participants generally reported mild levels of fear. A total of 38 subjects, accounting for 63.3% of the sample, had low scores in resilience. The participants’ responses indicated that their perceptions of mental health were within a fairly high range, with an average score of 3.62 ± 0.87. Similarly, their perceptions of physical health were also moderately high, with an average score of 3.73 ± 0.95. In terms of global health, participants reported a slightly lower average score of 3.27 ± 0.82 for the preceding month. The Pearson correlation matrix revealed statistically significant associations between fear of COVID-19 and characteristics linked to mental health, with the strength of these associations ranging from moderate to high (p < 0.001). The identification of predictive variables for fear of COVID-19 was accomplished by the use of a multiple linear regression model. Four predictors were identified in the study, namely age, perception of mental health, and overall levels of anxiety and stress. These predictors together account for about 49.7% of the variance in the outcome variable.

The findings of our research indicate a significant prevalence of stress among incarcerated individuals, accompanied by moderate levels of anxiety and depression. Our research has the potential to provide valuable insights for policymakers, mental health professionals, public health specialists, and other relevant stakeholders in the identification and effective management of pandemic-induced anxieties and mental health symptoms.

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Impulsivity is the tendency to take quick and rash actions without the ability to assess their consequences, resulting in an increased frequency of risky behaviors. In recent years, it has been indicated that impulsivity is a multidimensional construct with different ways of expression in various mental illnesses. Moreover, personality traits might predispose do different psychiatric diagnoses and impact its course.

Because differences in the manifestation of impulsivity can be observed at several levels (e.g., behavioral/motor, cognitive, attention, or emotionally related), we applied several tools to check whether they would allow for the differentiation of unipolar (UD) and bipolar (BD) affective disorders.

The study used data from 282 patients with affective disorders and 95 healthy controls of both sexes. Among the patients, we distinguished a subgroup diagnosed with UD and BD. We included a homogeneous group of patients in euthymia state at the end of hospitalization due to the last depressive episode. The following tools were used: subdimension novelty seeking (NS) of The Temperament and Character Inventory (TCI) and The Barratt Impulsiveness Scale version 11 (BIS-11) to assess various dimensions of impulsivity. The Coping Orientation to Problems Experienced (COPE) was used to assess the strategy of coping with stress. Statistical analyses were performed in Statistica 13.3 StatSoft, Krakow, Poland.

We observed significant differences in BIS-11 dimensions such as motor (MI) (p=0.0006), nonplanning (NP) (p=0.0249), and the sum of impulsivity (p= 0.0095) between UD and BD patients. We found no significant differences in the intensity of impulsivity measured by the NS subdimension, regardless of the type of affective disorder. In the Spearman rank correlation analysis, the following correlations of novelty seeking were revealed (p>0.05):

NS with BIS-11 MI (rs=0.3877, p=0001), BIS-11 NP (rs=-0.2926, p=0042) and COPE-planning (rs=-0.2552, p=0191) dimensions. Moreover, a unique and strong correlation of NS with COPE - focus on and venting of emotions was revealed in BD patients (rs=0.5402, p=0.0461).

The obtained correlation results confirm the multidimensional nature of impulsivity. The relationship between NS and the motor and nonplanning dimensions comes to the fore. Among the tests used, BIS-11 best differentiated unipolar and bipolar patients.

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Adopting a traditional healthy eating pattern is strongly associated with a more stable, adaptive, and serene mood. In contrast, adopting a modern and industrialized diet is linked to a higher incidence of anxiety and depressive disorders.

To prevent mood disorders, a varied diet rich in colorful fruits and vegetables is recommended. Studies show that the consumption of vegetables, whole grains, and fruits can help prevent the risk of major depression and anxiety disorders by more than 35%. A well-rounded plate, rich in micronutrients (trace elements, vitamins, minerals), is essential for the proper functioning of our brain and its emotional areas.

Our brain requires significant amounts of iron, zinc, magnesium, and vitamins B, E, D, and K. Unfortunately, our modern diet often lacks sufficient intake of these essential micronutrients. A deficiency in iron or zinc is associated with a significantly higher risk of major depression, and a lack of magnesium is a potential source of anxiety disorders.

Choosing a diet rich in micronutrients (whole grains, cereals, fresh fruits, and vegetables) can address potential deficiencies and contribute to a more adaptive and balanced mood. Similarly, carefully selected dietary supplements can prove to be effective.

it shows the importance of alimentation and her role on Primary and secondary prevention in depressive disorders.

This poster is a prospective study done on 100 random people via a multi choice quizz, to see the impact of their food on their mental health .

in the making

Food should today be universally considered as a potential risk factor or protective factor in depressive disorders. Since the recent decades, nutritional psychiatry has developed a field of research promising The International Society For Nutritional Psychiatry Research (ISNPR) who is a collective of doctors and researchers with the common objective of advance research and communication of nutritional medicine in the field of psychiatry. Cross-sectional epidemiological studies finding an association between diet quality and mental health in longitudinal studies, a step has been taken. The observational data have been widely replicated and documented in several meta-analyses and are supported by prospective studies studying the effectiveness of improving nutritional quality in the treatment of depression. It now appears necessary that in the near future psychiatrists must receive training on the impact of diet in psychiatric disorders including depression, and get into the habit of taking an interest in the eating habits of their patients, as well as their microbiota .

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The Positive and Negative Syndrome Scale (PANSS) has been used as a universal instrument for clinical assessment of psychopathology in schizophrenia. Different studies have analyzed the factorial structure of this scale and have suggested a five-factor model: positive, negative, excited, depressive, and cognitive/disorganized factors. Two of the most used models are the Marder´s solution and the Wallwork´s one.

The aim of this work was to study the correlations of the two cognitive factors (Marder and Wallwork) with a cognitive assessment performed with a standard cognitive battery, in a sample of patients with first psychotic episode of schizophrenia.

Seventy four patients with first psychotic episode of schizophrenia (26.9, SD:7.8 years old; 70.3% male) were included. The cognitive assessment was performed with the MATRICS Consensus Cognitive Battery (MCCB). The MCCB present seven cognitive domains: Speed of processing, Working memory, Attention/Vigilance, Verbal Learning, Visual Learning, Reasoning and Problem Solving, and Social cognition). Pearson correlations were performed between MCCB scores and Marder´s PANSS cognitive factor (P2, N5, G5, G10, G11, G13, G15) and Wallwork´s one (P2, N5, G11).

Correlation between MCCB scores and cognitive factors of Marder and Wallwork can be seen in the table.

Both PANSS cognition factors show a moderate correlations with Speed of processing, Working memory, Attention/Vigilance and Verbal Learning assessed by MCCB. More discrete correlations were found with Visual Learning, Reasoning and Problem Solving, and with Social cognition (in fact, non-significant correlation with Wallwork´s cognitive factor was found).

Acknowledgements. This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project PI19/00766 and co-funded by the European Union.

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Negative symptoms (NS) are an important clinical characteristic of schizophrenia. In recent years, clinical research on NS has focused on their clinical heterogeneity. Based on two-factor analysis, it has been proposed to divide NS into abulia-apathy (AA) and expressive deficit (ED) domains. A number of studies have shown that these domains have different effects on the clinical features of schizophrenia, which suggests different pathophysiological mechanisms of their development. Neurobiological differences between AA and DE have been identified in neuroimaging and immunological studies but there is less research on the genetic background of NS.

To search for an association between the rs1344706 polymorphism of the zinc finger protein gene (ZNF804A) and the AA and ED subdomains. The rs1344706 polymorphism is one of the best-supported risk variants for schizophrenia. The risk genotype AA has been shown to be associated with clinical presentations of the disease.

The study included 1116 (741 (66.3% women) patients with schizophrenia. The diagnosis was made according to ICD-10 criteria (item F20). The average age of the patients was 38.4 (13.6) years, age at disease onset was 26.1 (10.6) years. NS were assessed with the PANSS. The PANSS-derived AA domain consisted of Emotional withdrawal (PANSS item N2), Apathetic social withdrawal (N4), Active social avoidance (G16). The DE domain included Blunted affect (N1), Poor rapport (N3), Lack of spontaneity (N6), Mannerism and posturing (G5), Motor retardation (G7), Disturbance of volition (G13). Genotyping of the ZNF804A rs1344706 polymorphism was carried out using HRM-PCR. ANOVA with genotype and sex as independent variables, and age at the time of disease manifestation and its duration as covariates was used. Post hoc tests were performed using Bonferroni correction.

A significant effect of the rs1344706 polymorphism on the severity of symptoms in the AA domain was revealed (F=5.88, df=2, p=0.002). In carriers of the CC genotype, the severity of symptoms was significantly lower than in carriers of the AA genotype and the AC genotype (8.4(3.5), 9.4(7.4) and 8.8(3.5) points, respectively). This effect was independent of sex and was not mediated by age at onset or duration of disease. There was no effect of the rs1344706 polymorphism on the severity of symptoms in the ED domain.

The association of the ZNF804A rs1344706 (A/C) polymorphism with NS of schizophrenia has not been reported so far though some studies have found the effect of this polymorphism on  PANSS positive symptoms and PANSS total score. The finding of the association with NS can be explained by the fact that the NS heterogeneity was taken into account in the present study.

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Legal professionals frequently encounter forensic mental health issues in the criminal justice system. These issues can significantly impact the outcome of cases, making it essential to understand the attitudes and perceptions of these experts towards mental illness. Despite a high number of individuals with mental illness in prisons, the availability of forensic mental health services is limited. While prior research has shown widespread stigma towards mental illness, there hasn’t been a study assessing the attitudes of judges and lawyers.

This study aims to investigate the stigma related to mental health among Lebanese legal professionals.

An online questionnaire was sent to judges and lawyers practicing in Lebanon. The survey included a section on demographics and personal data with the following scales: Reported and intended behavior scale (RIBS) which measures mental health stigma–related behavior and Perceived devaluation and discrimination scale (PDD) measuring the extent to which a person believes that most people will devalue or discriminate against someone with a mental illness.

A total of 215 participants, with a mean age of 38.69 and a mean 13.16 years of experience, completed the questionnaire. Most were female (62.8%) and worked as civil attorneys (47.4%). Only a minority received instruction on mental health or mental health law during training (10.7% and 8.8%). About a quarter believed their education on mental health issues was sufficient (27%). Participants with positive attitudes (RIBS) were more likely to have a family member with a mental illness (p value = .001), feel comfortable handling cases involving mental health (p value = .001), and have lived with someone with a mental illness (p value = .007). Feeling adequately educated about mental health issues was associated with lower perceived stigma (PDDS, p value = .021). No significant associations with stigma scores were found for factors like age, gender, occupation, years of experience, contact with a mental health professional, taking psychotropic medications, disclosing personal mental health issues to friends or co-workers, receiving education on mental illness or mental health law, or working with individuals with mental health issues.

The findings imply that enhancing mental health education and awareness within the legal profession could be a key strategy to reduce stigma and improve the overall treatment of individuals with mental health issues within the criminal justice system in Lebanon.

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Presence of the disabled child in the family poses many challenges for their siblings, especially in adolescence. Children with disabled siblings often receive less attention from family and friends, experience a sense of injustice and anger towards sick siblings, as well as they are more likely to experience various somatic complaints and higher levels of depression and anxiety. However, research shows that resiliency could be a protective factor associated with the functioning of children and adolescents in certain life events, such as sibling’s disability, referring to good adaptation despite facing emerging adversities.

Therefore, the aim of the current study was to examine the role of resilience as a possible protective factor for the occurrence of internalizing and externalizing disorders in adolescents having disabled sibling.

175 diads of a healthy adolescent and one of its parents (N = 350) participated in the study. Participants were divided into two groups - 119 diads in the group with disabled sibling (Madolescent’s age = 16.70; SD = .66) and 56 diads in the group with a healthy sibling (M adolescent’s age = 16.64; SD = .75). The following measures were used in the study: Resilience Measurement Scale (SPP-18) and Child Behavior Checklist for Ages 6-18 (CBCL/6-18).

The results showed no statistically significant differences in any of the measured resilience factors (optimistic attitude and energy, persistence and determination in action, sense of humor and openness to new experiences, personal competences and a tolerance for negative affect), in adolescents with disabled sibling, comparing to the control group. However, adolescents with disabled sibling were found to have a significantly higher risk of the occurrence of both, externalizing and internalizing disorders compared to adolescents with healthy siblings. Furthermore, findings of the study also confirmed that personal competences and a tolerance for negative affect predicts lower risk of the occurrence of internalizing disorders in adolescents having disabled sibling.

Our findings highlights that resilience may have important role in reducing the risk of the clinical problems occurrence in adolescents having disabled sibling. Therefore, comprehensive psychological support enhancing their personal growth and competence should be provided in the above group.

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Current guidelines for managing antipsychotic-induced hyperprolactinemia recommend the use of aripiprazole, either as a substitute or in combination with the primary antipsychotic. However, there have been reported cases of exacerbated psychotic symptoms when introducing aripiprazole after chronic treatment with another antipsychotic.

We present a case of a patient with unspecified schizophrenia spectrum disorder receiving amisulpride, who developed worsened psychotic symptoms following the introduction of aripiprazole to treat hyperprolactinemia. We also review this phenomenon and its clinical management in the literature.

Clinical case report and brief literature review.

Ms. G, a 54-year-old woman diagnosed with unspecified schizophrenia spectrum disorder, was on amisulpiride 400mg/day and had remained asymptomatic for months. During a follow-up, she complained of mastalgia and had a prolactin level of 71.7 ng/mL. Following clinical guidelines, aripiprazole was added at 10mg/day. Within a month, anxiety and sleep disturbances escalated, followed by the reappearance of psychotic symptoms. Aripiprazole was discontinued, amisulpride reinstated, achieving stability. Subsequently, hyperprolactinemia was managed using metformin.

Antipsychotic-induced hyperprolactinemia is common, especially with first-generation antipsychotics, causing various symptoms in both genders. Long-term consequences may include weight gain, reduced bone density, and potentially increased breast cancer risk, among others.

Aripiprazole is an atypical antipsychotic with a partial agonist effect on dopamine D2 and D3 receptors. This means that aripiprazole will act as a functional D2-antagonist under hyperdopaminergic conditions, but a functional D2-agonist under hypodopaminergic conditions. This property of aripiprazole may contribute to counteract ‘prolactin-raising’ agents, acting as a D2 agonist, potentially reducing prolactin rise.

Chronic use of presynaptic D2/D3 antagonist (amisulpiride) might create a hypodopaminergic environment and hypersensitivity to dopamine agonists, possibly explaining worsened symptoms with aripiprazole introduction.

To prevent adverse outcomes when adding or switching to aripiprazole, gradual reduction of the previous antipsychotic (amisulpride) and high-dose aripiprazole initiation (30-40 mg/day) can help.

Antipsychotic-induced hyperprolactinemia is a serious issue that deserves our attention. While aripiprazole is recommended by several guidelines to treat it, introducing it to patients on chronic antipsychotic treatment may lead to a worsening of psychotic symptoms. Caution is recommended when combining aripiprazole with potent D2 receptor blockers. To mitigate this effect, gradual dose reduction of the previous antipsychotic and high-dose aripiprazole initiation are crucial.

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Sodium oxybate, an effective treatment for narcolepsy-associated daytime sleepiness and cataplexy, has been extensively. Despite its therapeutic benefits, sodium oxybate is not without its risks, and adverse psychiatric effects have been documented. This case report highlights a rare manifestation of sodium oxybate-related secondary mania with psychotic symptoms in a patient with narcolepsy, emphasizing the importance of recognizing and managing such adverse events. Additionally, we provide a brief review of similar cases reported in the literature.

This report aims to describe the presentation, evaluation, and management of sodium oxybate-induced secondary mania with psychotic symptoms in a patient with narcolepsy. We also discuss the potential mechanisms underlying this adverse reaction and its clinical implications. Furthermore, we summarize findings from previous studies that have reported cases of secondary mania associated with sodium oxybate use.

We present the case of Mr. X, a 48-year-old male diagnosed with “Narcolepsy with cataplexy,” who had been receiving sodium oxybate treatment for 11 years. He was admitted to the hospital following a mild head injury and the emergence of a manic episode with psychotic features. Comprehensive clinical evaluation, including medical history, toxicology screening, and neuroimaging, was conducted.

Upon evaluation, Mr. X exhibited hyperactivity, restlessnes, grandiose delusions, paranoid delusions related to hospital staff, and decreased need for sleep. Notably, he had been consuming sodium oxybate excessively. Sodium oxybate was discontinued, and low-dose olanzapine was initiated. Within 24 hours, his manic and psychotic symptoms resolved. He admitted to overusing his medication, and his family reported a recent increase in his activity level. A review of the literature revealed similar cases of sodium oxybate-induced secondary mania with psychotic symptoms.

This case underscores the importance of vigilance for psychiatric side effects of sodium oxybate, particularly in patients with a history of substance abuse or potential overuse. Secondary mania associated with medications is a rare but significant clinical entity. Prompt recognition and intervention are crucial for patient safety and well-being. Further research is needed to elucidate the mechanisms underlying such reactions and to establish guidelines for their prevention and management.

None Declared

Psychotic disorders are significant comorbidities in young people with Autistic Spectrum Disorder (ASD). Evidence suggests that ASD & psychosis present with overlapping clinical features & cognitive symptoms leading to misdiagnosis (Trevisan et al. Front.Psych 2020;11:548). Clinicians encounter diagnostic dilemma during assessment of psychosis in adolescents with ASD.

To discuss the clinical challenges in the assessment & treatment of young people with ASD & comorbid psychosis.

A case report of a young girl with ASD & comorbid psychotic illness.

A young girl with ASD was admitted to CAMHS inpatient Unit with unusual beliefs & perceptual disturbances. She reported hearing the voice of ‘Hydrogis’ who was talking to her about his girlfriend. She made a voodoo doll & tried to set it on fire, as she believed that this would kill the girlfriend. She also heard voices of characters from a TV show, discussing her in third person. She absconded from home due to the distress associated. She attempted suicide by tying a ligature. She was seen responding to external stimuli, laughing incongruously & was thought disordered. Despite never being to USA, she spoke in American accent. She lacked insight & struggled to differentiate reality from fantasy. The aim of admission was to determine if the symptoms were part of ASD or a psychotic disorder. She had medication free assessment but continued to be very distressed. We commenced Aripiprazole which was optimised. She responded well to the treatment & was discharged to the care of Early Intervention in Psychosis team with partial remission of symptoms.

Historically psychotic illnesses & ASD were thought to be closely linked. Research suggest that they are two separate disorders with specific onset, progress, signs & symptoms. ASD might be misdiagnosed as psychosis as difficulties in communication may resemble thought disorder, ‘melt down’ may mimic catatonia & difficulties in recognising others’ intentions may mimic paranoia. Our patient was experiencing first episode psychosis in late adolescence. This age of onset is consistent with research findings. A study to differentiate between ASD & psychosis found that positive symptoms like hallucinations & delusions were suggestive of psychosis while odd emotional gestures, stereotyped speech & restricted interests indicated ASD. Our patient predominantly had positive symptoms of delusions, hallucinations & thought disorder, hence our diagnosis of psychotic episode. In some cases, it is difficult to differentiate childhood fantasies from delusional beliefs (Ribolsi et al. Front.Psych 2022;13:768586). Bleuler explains that children with ASD replace imperfect realities with imaginations & hallucinations but Michael Rutter claims that autistic children lack fantasy. There are varying views on this subject & this is the challenge we faced when treating this young person.

None Declared

Childhood trauma encompasses instances of sexual, physical, and emotional abuse, along with neglect experienced during childhood and adolescence. Individuals with psychosis, particularly those with schizophrenia, exhibit a heightened prevalence of childhood trauma. One potential mediator in understanding this connection is insecure attachment.

This study aimed to better understand how childhood trauma relates to schizophrenia by examining two aspects of attachment: attachment anxiety and attachment avoidance.

We conducted a descriptive and analytical cross-sectional study among stabilized female patients with schizophrenia or schizoaffective disorder, in the ‘B’ psychiatry department at Hedi Chaker University Hospital in Sfax, Tunisia, from May to June 2023. We administered the 26-item Revised Psychosis Attachment Measure (PAM_R) questionnaire, translated into Arabic, to assess attachment. Additionally, participants completed the 28-item Childhood Trauma Questionnaire (CTQ). We used both the Wilcoxon test for paired samples and the Spearman correlation test to assess the statistic differences and correlations.

We included 41 female patients, of which 65.9% had schizophrenia and 34.2% had schizoaffective disorder. The average age of the participants was 49.19 years. Among the attachment styles, avoidant attachment was the most prevalent (60.97%), followed by anxious attachment (24.39%), and disorganized attachment (14.63%). Regarding childhood trauma, the average total score on the Childhood Trauma Questionnaire (CTQ) was 56.34. Specifically, 39% of patients reported experiencing physical abuse, 24.4% reported sexual abuse, 14.6% reported emotional abuse, and 4.9% reported physical neglect. The Spearman correlation analysis between avoidant attachment and scores on the Childhood Trauma Questionnaire (CTQ) yielded a diverse set of findings. It indicated a significant positive correlation with physical abuse (ρ = 0.004, p < 0.001), a significant negative correlation with emotional abuse (ρ = -0.045, p < 0.001), a significant positive correlation with sexual abuse (ρ = 0.036, p < 0.001), a significant negative correlation with physical neglect (ρ = -0.083, p < 0.001), a significant negative correlation with emotional neglect (ρ = -0.047, p < 0.001), and a significant positive correlation with denial (ρ = 0.080, p < 0.001). On the other hand, the Spearman correlation analysis between anxious attachment and scores on the CTQ showed varying correlations: a significant positive correlation with physical abuse (ρ = 0.094, p < 0.001) and sexual abuse (ρ < 0.0001, p = 0.05).

Our findings indicate that individuals with an insecure attachment style and a history of childhood trauma should be considered a high-risk group, necessitating early clinical intervention, continuous monitoring, and personalized therapeutic approaches designed to alleviate the psychological effects of trauma.

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Workplaces can be source of significant stress for employees, leading to a series of mental health problems, such as burnout syndrome. Healthcare professionals and other helping professions are especially vulnerable to work-related stress.

The aim of the present review is to assess available intervention aiming at improving work-related stress symptoms.

We conducted a thorough search of relevant articles on PubMed, APA PsycInfo, and Scopus databases, using specific keywords such as “occupational stress,” “stress,” “anxiety,” “depression,” “health personnel,” “health care facilities, manpower and services,” “prevention,” and “control.”

Although significant methodological heterogeneity has been found among studies, regarding assessment tools, target population, and intervention types, we can still draw some satisfactory results. Healthcare professionals have access to various interventions to manage work-related stress symptoms, which can be classified into three categories: 1) individual cognitive-behavioral therapy approaches, 2) relaxation techniques at the individual level, and 3) organizational-level interventions. Mindfulness techniques, relaxation techniques, emotional freedom techniques, and integrated interventions have demonstrated effectiveness in alleviating work-related stress.

To prevent work-related stress among healthcare professionals, interventions should be targeted towards specific categories of healthcare workers based on factors such as age, tasks, and patient types. Well-structured and reliable randomized controlled trials focusing on the most promising interventions, such as mindfulness, need to be carried out in larger samples and with a solid methodology in order to confirm these evidences.

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It is still being discussed whether treatment-resistant schizophrenia (TRS) is a biological subtype which differs from non-treatment-resistant schizophrenia or is it a more severe condition that affects brain worse than non-treatment-resistant schizophrenia. However, there are few and heterogeneous studies and the etiology of TRS remains quite unclear.

This study aimed to explore cortical and subcortical morphometric characteristics in TRS patients and its associations with the clinical features. The pilot stage comprises the comparison to the mentally healthy subjects.

21 right-handed male patients (mean age 28.99 ± 8.08 years) fulfilling TRS criteria and 21 matched healthy controls (mean age 29.35 ± 7.41 years) underwent T1-weighted structural MRI at 3T Philips scanner and clinical examination. Images were processed using FreeSurfer 7.1.1. Cortical thickness and area, volumes of subcortical structures and separately volumes of the amygdala nuclei and hippocampal subregions were compared between groups. The morphometry data, PANSS (Positive and Negative Syndrome Scale), CDSS (Calgary Depression Scale for Schizophrenia) and daily chlorpromazine equivalent doses of antipsychotics were included in correlational analysis. Results were considered significant if they retained significance after correction for multiple comparisons.

Compared to healthy controls, TRS patients showed decreased gray matter thickness in frontal, temporal, parietal, occipital, cingulate and insular regions (Figure 1). The temporal lobe showed the most prominent thinning of the cortex. The volumes of the amygdala, hippocampus (Figure 2) and nucleus accumbens, a number of amygdala nuclei and hippocampal subregions bilaterally were also decreased in TRS patients. The volume of the right globus pallidus, on the contrary, was increased (Figure 2). No correlations between altered cortical thickness, PANSS (positive, negative, general psychopathology scales and total score), CDSS and chlorpromazine equivalent doses of antipsychotics were found.

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The widespread gray matter cortical and subcortical loss in TRS finds confirmation in the literature. The increased globus pallidus volume is an unexpected and intriguing result. Other studies demonstrated conflicting results on that point. Some studies reported possible therapy influence, others suggested possible associations with symptoms. We did not find any correlations with psychometric or therapy characteristics. It is possible that there are non-linear relationships or relationships that exist only at a certain stage of the disease. As for therapy, patients took individual medication, consisting of various antipsychotics and drugs from other pharmacological groups, and such heterogeneity could affect the results of the study. Further research is going to be carried out.

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The nature of psychiatry as a specialty dealing with mental health and emotional well-being may contribute to the perceived stigma. These misconceptions and biases can impact the way psychiatry residents perceive their profession, their own self-esteem, job satisfaction, and overall well-being.

Our goal was to evaluate the experience of stigma among psychiatry residents.

A descriptive cross-sectional online survey was conducted in January 2022 among psychiatry residents at Hedi Chaker University Hospital in Sfax, Tunisia.

The Clinician Associative Stigma Scale (CASS) was used to assess stigmatization experiences.

A total of 34 residents participated in this survey. Their average age was 27.94 years ± 2.43, with 91.2% being female. Of the participants, 61.8% were adult psychiatry residents, and 39.2% were child psychiatry residents. Additionally, the choice of adult psychiatry or child psychiatry specialty was self-determined in 91.2% of cases. The participants had an average of 2 years of experience in psychiatry. They reported a personal medical or surgical history, a personal psychiatric history, and a family history of psychiatric disorders in 32.4%, 8.8%, and 50%, respectively. The average CASS score was 47.09 ± 8.32.

The mean scores for the “discomfort with disclosure” factor, the “stereotypes about mental health professionals” factor, the “negative stereotypes about individuals with serious mental illness” factor, and the “negative stereotypes about effectiveness” factor were respectively 8 ± 3, 9.44 ± 2.57, 15.62 ± 5.7, and 11.35 ± 3.33.

Our study highlighted that residents in psychiatry suffered stigma. Special attention should be given to reducing this phenomenon in this population.

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Perfectionism is often seen as a beneficial trait for trainee doctors since it means they have high standards and a drive for success. However, it demands a flawless level of performance regardless of one’s physical or mental health and well-being. Consequently, perfectionism is now viewed from a different perspective.

We aimed to study the impact of perfectionism among doctors in training on their self-esteem.

We conducted a cross-sectional descriptive and analytical study among trainee doctors. The following psychometric instruments were used: The “Work Addiction Risk Test” and the “Rosenberg Self-Esteem Scale”.

We included 99 doctors in training. Their mean age was 27.6± 2.2 years. The sex ratio (♂/♀) was 0.33. Most participants were single (63.6%) and of middle socioeconomic level (86%). Tobacco use was reported in 6.1% of cases, and alcohol use in 4.1% of cases. Among all participants, 58 % had low or very low self-esteem. The mean score of Rosenberg Self-Esteem Scale was 30±5.13 and the mean score of the big three perfectionism scale short form was 41.11±13. Higher self-esteem scores was significantly associated with lower self-critical perfectionism scores.

Our results point to the negative impact of self-critical perfectionism on self-esteem. In fact, perfectionism can hold you back, both personally and professionally. Perfectionists see their own self-worth as tied to what they achieve, and they believe that others judge them on this as well. They can never live up to the standards they set for themselves, and this can lead to a downward spiral of self-criticism and blame.

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