Difficult patients are not something new and we can find innumerous definitions for this concept. However, they form a very heterogenous group and we need a less abstract definition focused more on the clinical reality and the difficulties experienced by patients and mental health professionals.

Our goal was to find a more precise and clinical definition of the difficult patient based on quantitative measures using a statistical analysis of a series of hospitalizations.

A cluster analysis of our hospital’s in-patient treatment from the last 5 years was made concerning the duration of the stay and the number of previous hospitalizations.

A sample of 8576 inpatient treatment episodes was used. 52.4% were male and 47.6% female patients between the age of 15 and 103 years old. The length of the treatment varied from 0 to 1007 days and the number of previous hospitalizations from 0 to 109; excluding the outliers the means were, respectively, 21 days and 2 previous hospitalizations.

The cluster analysis excluded 85 episodes and it found the presence of 3 clusters, being the number 1 the wider one (n=5861 episodes) and the other quite similar.

The Cluster 1 was characterized by a smaller length of hospital stay and number of hospitalizations; the Cluster 2 was defined by the episodes with the highest number of previous hospitalizations (`x =8.77) and the Cluster C by the longest hospital stays (`x =58.09 days). With a Kruskal-Wallis test we found both variables statistically different between all clusters (p<0.001). In Cluster 2 and 3, respectively, we found that 40,24% and 34.61% was taking the medication before being hospitalized, 6.42% and 3.15% were compulsive hospitalizations, and 40.5% and 21.89% had LAI prescribed.

Concerning the diagnosis, Cluster 1 had more Depression, Neurotic and Somatoform disorders; Cluster 2 more Bipolar and Intellectual disability disorders and Cluster 3 more Dementia and Delusional disorders. Substance use disorders and Personality disorders were found more common in both Cluster 1 and 2, Schizophrenia in Cluster 2 and 3 and Psychosis non specified in Cluster 1 and 3.

We can say Cluster 1 comprises the non-difficult patients and it’s not surprising that it includes more Depression and Neurotic and Somatoform disorders. The other diagnostic distributions among clusters were also expected and we can also theorize that Cluster 3 had higher percentages of social cases. Treatment with LAI is linked to a decrease in rehospitalizations and we found that in the majority of these episodes it wasn’t been applied. This research is important in order to identify the difficult patients and what challenges they can bring to the mental health services. Creating these patients’ profile will allow us to better understand their needs to create guidelines for a personalized inpatient treatment and to improve community services to prevent the rehospitalizations and prolonged hospital stays.

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Alcohol and Drug use is an important Public Health problem, it has a negative impact on the cognitive and individual behavior. IPV has been frequently connected to drug alcohol and drug use.

The aim of this study is to explore the relationship between IPV and alcohol abuse.

An observational and descriptive study was carried out using the internet platform “google forms”, after requesting the informed consent of each of the participants, we collected the data of affiliation and the Test of Identification of Disorders due to Alcohol Consumption (AUDIT) with the Drug Use Disorders Identification Test (DUDIT) was applied to identify individuals with a pattern of harmful consumption of substances harmful to health as alcohol and drugs.

The total sample was 851, it was classified according to age, sex, marital status, level of education, urban or rural population, and whether they had suffered any type of violence associated with alcohol abuse. The mean age: 26 - 27 years old. The results according to the AUDIT TEST: 562 (66%) reported not having suffered any type of violence, 289 (34%) reported some type of violence, 157 (18%) psychological violence, 10 (1%) psychological violence and patrimonial violence, 16 (2%) psychological and sexual violence.

This study established an important population who has suffered Psychological Violence. Other types of Violence has been determined. it is important to highlight that these results showed an important information to work on prevention. Further studies are an urgent need.

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Severe mental illnesses characterized by periods of relapse that require intensive resource management. Caregivers of schizophrenia and bipolar disorder patients feel a considerable burden of care (Tanna et al. Ind Psychiatry J 2021, 30(2):299-304).

The main objective of Hospital at home for psychiatric patients is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission (Alba et al. Rev Psiquiatr Salud Ment. 2019, 12 (4) 207-212).

The aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital (HAD-CAEM) and to assess the of burden of care that caregivers feel while giveing care to this patients.

Data were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between August 2018 to March 2022. Incomes of patients who met DSM-5 criteria for schizophrenia, bipolar disorder and major depressive disorder. Severity of disease and patient’s level of functionality was evaluated with the global assessment of functioning scale (GAF) and the Clinical Global Impression Scale (CGI). Burden Caregivers was evaluated with The Zarit Caregiver Burden Scale (ZCBS). Statistical analysis was performed by using SPSS program.

109 patients were included in the study. 49.5% were women. The mean age was 48 years (SD 18.47 years). 44% met criteria for schizophrenia, 25.7% for depressive disorder, and 30.3% for bipolar disorder. Most of them lived with their own family (47.7%); had secondary education (51.4%) and were unemployed (33%). 81% had a history of at least one admission to an acute psychiatric unit.

The mean duration of admission in HAD-CAEM was 33.8 days (SD 15.72 days), with a mean follow-up of 8.75 visits (SD 3.58 visits).

The mean CGI severity item at admission was 4.36 and there was an improvement at the time of discharge according to the CGI improvement item (mean CGI-I=2.43).

The GAF scale on admission was 46.74 (SD 11.2) and on discharge 64.24 (SD 13.85), showing an improvement of 17.5 points at discharge (p<0.001).

The mean ZCBS of the sample was 48.21 (SD 15.11). Mean ZCBS in Schizophrenia group (n=22) was 46.13 (SD 16.53), in depressive group (n=18) was 43.61 (SD 12.89) and for bipolar group (n=17) was 55.76 (SD 13.19). A statistical test is performed with ANOVA, showing significant differences between groups (p=0.039). Post-hoc analyzes show significant differences between bipolar disorder group and the depressive disorder group (p=0.04). No significant differences are found between the other groups.

Caregivers of schizophrenia, depressive and bipolar disorder patients feel a considerable burden of care. ZCBS was administered to the caregivers on the last day of admission, when the patient presented clinical and functional improvement. More studies are needed to support these results.

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New technologies have been steadily impacting and redefining the health care landscape over the last decades, a process recently enhanced by the covid-19 pandemics . VR is an advanced media that can simulate highly realistic virtual environments, providing a high sense of immersion (the feeling of “being really there”). VR has expanded its healthcare application over the last years. Surprisingly, the acute psychiatry ward has been, so far, systematically left out of the VR application field. Psychiatric wards are complex environments. Patients are frequently admitted against their will and many wards have a locked doors policy, with subsequent feelings of seclusion experienced by patients. Therefore the question emerges: could VR help psychiatry inpatients have a better experience during their hospitalization?

This is a pilot study where psychiatry inpatients are offered a single session with the Oculus Quest 2, where they are immersed in a computer generate scenario provided by a commercially available software (“Nature Treks”). The scenario is a nature-based immersive 360° walk. Patients are allowed to freely explore the scenario with no time restraints.

The STAI (State-Trait Anxiety Inventory), and the PANAS (Positive and Negative Affect Schedule) questionnaires are completed by patients before and after the VR exposure. After exposure, patients are also asked to complete the SUS (System Usability Scale) questionnaire, the IQ-presence questionnaire and the SSQ (Simulator Sickness Questionnaire). Electrophysiological recordings are gathered with the Empatica E4.

Up to date, 4 patients have been recruited. The sessions have lasted around 10 minutes. Reductions in the STAI and the PANAS have been reported by 3 patients (with no statistical significance so far). Usability has been extremely high as reported by the SUS. Minimal adverse reactions to VR use have been reported in the SSQ, mainly dizziness and nausea.

VR has a high potential to ameliorate the conditions of psychiatry inpatients admitted to a close-doors ward. As with many technological novelties, implementation and sustainability will be key. The small evidence provided by this pilot study points out to an initial good acceptability and potential efficacy in some patient-related outcomes.

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Mental health deteriorated worldwide during the COVID-19 pandemic. The healthcare sector recognises the role of nature in mental health. Passive and active interactions with nature reduce stress, anxiety, and depression. Theoretical frameworks for mental health benefits from nature interventions include medical, evolutionary, relational, eco-psychological and human activity perspctives.

To assess the usefulness of the nature-based interventions in relation to well-being improvement.

The six-month survey was carried out in a forest in the administrative district of the capital city of Warsaw.Over 70 adult volunteers took part in structured sessions of active nature-based interventions, lasting ca. 1.5 hour.The forest bathing methodology was based on the review literature. Participants anonymously filled in on-line semi-structured questionnaire containing GHQ-30, DASS-21 andlife satisfaction. questionnaire. Between sessions, participants were asked toassessment their mood profile and life satisfaction. After every session they assessed particular interventions in terms of usefulness on 5-point Likert scale.

The authors will present the results of the study and key findings.

It is expected that the study may provide a significant contribution to the knowledge’ development about the nature-based interventions. In particular, we can learn about the impact of several interventions (active exercise, visualization, mindful walking, mindfulness perception) on improving the well-being of participants.

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Research shows the benefits of music therapy for various mental health conditions, including depression, trauma, and schizophrenia. Music acts as a medium for processing emotions, trauma, and grief.

Playing instruments can encourage emotional expression, socialization and exploration of various therapeutic themes (i.e. conflict, communication, grief, etc.).

Group music therapy, measured by questionnaires and described in qualitative interviews, improved quality of life and self-esteem for people with severe mental illness (SMI).Group singing and song writing provide creative options for social connections. Music therapy should be considered as a component of holistic care for people with SMI. Jungup Lee, Thyer BA. May 2013Journal of Human Behaviour in the Social Environment 23(5):597-609

Music therapy sessions are held in our hospital for people admitted to short-term hospitalization units and to psychosocial rehabilitation units. The goal of the sessions is to create a connection space, promote people’s confidence in their own resources for their recovery, and evoke valuable experiences and memories. Sometimes musicians from the community have been present in the sessions, contributing to overcoming the stigma towards mental illness.

We describe self-assessment of people admitted to psychiatric units after attending music therapy sessions. People from brief hospitalization unit filled out a survey, after each session, voluntarily, about their emotional state at the beginning of the session and after it. People from rehabilitation units, voluntarily filled the SRS V.3.0. 2002-Miller. Duncan & Johnson escale.The SRS was designed for use by clinicians to assess the therapeutic alliance during therapy (Duncan BL et al. The Session Rating Scale: Preliminary Psychometric Properties of a “Working” Alliance Measure JBT 3(1) 3-12 12/14/04 3:53 PM Page 3).

23 sessions took place for each unit. 39 patients from brief hospitalization, 22 women and 17 men, attended the sessions. 15 had a diagnosis of schizophrenia and related disorders, 13 were affective disorders, and 11 others diagnosis. All of them liked the participation either fully or partially. 76% men and 77% women felt better after, none of them reported to feel worse. 82% men and 86% women replied they would repeat the session.

Patients from rehabilitation units were 7 women and 10 men. 14 had a schizophrenia related disorder and 3 had bipolar disorder. All items on the scale were scored above 9 over 10, (I felt heard, understood, and respected/ We worked on and talked about what I wanted to work on and talk about/ The therapist’s approach is a good fit for me) with an overall score of 9,62 over 10 (Overall, today’s session was right for me).

Music therapy sessions achieve benefits on an emotional level in any of the diagnoses, improving alliance with care teams, who value sessions as normalizing spaces, helping to overcome stigma.

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Traditionally, psychiatric wards had established a “locked door” policy but secluded conditions may increase patient’s discomfort1 that could affect the perception of health quality of care2. Recently, the “open-door” policy is being adopted in several European countries but its impact on patient satisfaction remains unknown (Schreiber, LK. BMC Psychiatry. 2019 May 14;19(1):149). Since 2019 our psychiatric hospital has implemented the open-door policy.

The aim of this study is to investigate the impact of the “open-door” policy on patient satisfaction during their stay in the acute inpatient unit of our psychiatric hospital.

This is an observational study. Prior to the implementation of the open door policy 31 patient satisfaction data was collected between October 2018 to April 2019 and it was also assessed with 31 subjects between July to October 2019, after the implementation of the open “door-policy”. The inclusion criteria were being >18 years old, reading Spanish correctly and with a length of stay >72 hours. The patients with dementia disorder and intellectual disability where excluded from the study. We used the Satispsy-22-E scale, a self-administered questionnaire (Frías, V., et al. 2018. Psychiatry Res. Oct;268:8-14). It assesses patient’s experience of hospitalization through 22 items distributed into 6 dimensions. The score range is from 0 to 100. Differences in Satispsy-22-E scores were analysed by applying ANOVA using the IBM-SPSS (v. 25).

Total scores in Satispsy-22 are provided in Figure 1. We found that patient satisfaction was increased in the dimensions of “personal experience” and “food” (p<0.05). No significant differences were found in staff, quality of care, information, activity dimensions and Total score (Table 2).

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Our results provide preliminary evidence indicating that the open-door policy could have a positive impact on patient satisfaction, especially in relation to the personal experience on an acute inpatient psychiatric unit.

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Data regarding mental health problems in the prelingual deaf population is scarce. There is evidence that factors related to minority stress can contribute to mental illness in that population. In psychiatry, communication is key, however, most clinicians are not trained to communicate with the Deaf. Moreover, psychiatrists are often not aware of particularities in the psychopathology of these patients.

We aim to review important aspects of psychiatric evaluation of prelingual Deaf patients.

Non-systematic review of recent literature regarding Deaf mental health and mental illness.

Data regarding prevalence of mental illness in the Deaf population is mostly obtained from small studies and suggest an increased burden of mental illness and significant barriers to mental health care. Psychiatry research regarding Deaf patients is about 40 years behind research on the hearing population. While communicating with a Deaf patient, clinicians should consider the preferred communication modality. Sign-language interpreters should have specific mental health training, although that is not the case for many countries. Clinicians should keep communication simple, use short sentences, concrete examples and visual aids.

The mental status examination will have particularities, such as: 1) facial expressions have a specific role in sign languages and may not relate to affect; 2) There is a need to distinguish between language dysfluency and thought disorder 3) voice hallucinations may manifest as somatic or visual hallucinations; the occurrence of pure auditory hallucination in the prelingual Deaf is controversial. 4) the Deaf have little access to health information and are likely to demonstrate poor literacy on mental health matters.

More studies regarding the mental health issues of the Deaf population should be conducted. Raising awareness among clinicians about the needs of Deaf population is an important step to improve their access to help and treatment.

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Metabolic syndrome and other cardiovascular risk factors are highly prevalent in people with mental severe illness (Sun & Jang, 2020).Metabolic disorders in people with schizophrenia increase their risk of developing cardiovascular disease, consequently reducing their life expectancy by approximately 10 to 25 years (Heald et al., 2017)In part these cardio-metabolic risk factors are attributable to unhealthy lifestyle, including poor diet and sedentary behaviour.Lifestyle interventions (diet, increased physical activity) are the first-line treatments to decrease that risk.

Our objective is to carry out a prospective study on the application of a program of healthy habits in outpatients unit

Patients with mental severe illness were recruited at a mental health center in the Hospital Clinic of Valencia. Inclusion criteria: age from 18 to 65 years and diagnosis of severe/persistent mental illness Exclusion criteria: acute illness, were not understanding Spanish, not be able to read and understand questionnaries. We included following data: sociodemographic data and aspects of the health behaviors, anthropometric measurements and analytical with hemogram and biochemistry pre and post-intervention. All subjects gave informed consent for participation in the study.

We included 12 patients, but only 9 completed the full program. Average baseline data suggests that participants were at increased health risk when entering the program.At the end of the program, differences were observed: a reduction in glucose profile, a reduction of an average of 3.33 kg from the initial weight and a reduction of 10 points in blood pressure.

This real world pilot trial evaluate of a health promotion intervention targeting physical activity and healthy eating in mental health care using a specific programme.

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Shared decision making (SDM) is a health communication approach focusing on patient-clinician interactions around treatment decisions, with the goals of improving clinical and functional outcomes and providing personalized care. Moreover, decision making may need to be negotiated between, and communicated to, multiple health and social care practitioners, as well as patients and their social networks (SNs). The skills for sharing and discussing personal information with patients, and their SNs, can be hard to embed in mental health services. Compared to physical health, SDM in mental health is characterized by inconsistent definitions, models, and measurement, and evidence for the effectiveness of SDM interventions is inconclusive. Therefore, there is a need to define what is considered an effective SDM approach in mental healthcare, and to determine the core elements and steps required for its successful implementation in mental health populations.

To better understand the concept and role of patients’ social networks in treatment decision-making in mental health.

A two-phase process (compliant with the International Patient Decision Aid Standards) will be used to develop the first polyadic SDM measure of patient experience to support a wide range of models of mental health care. The new measure of patient experience will focus for the first time on the patient’s perception of individual qualities/behaviour of a patient, clinician, caregiver, and their interaction. Phase I of this thesis involved reviewing the existing SDM interventions and SN interventions in mental health, as well as reviewing the existing instruments used to measure SDM in mental health research and practice. Phase II will involve developing and revising the new measure of SDM using stakeholder feedback in an iterative process. Stakeholders will include patients, their caregivers, and clinicians recruited from community mental health services in England.

To define SDM and the most relevant aspects of it, data from the literature review and exploratory focus groups will be evaluated together. A pool of draft questions will be generated, covering all aspects of the identified themes. These questions will be further refined following discussions with people with lived experience of mental illness (i.e., peers) and academics who have the relevant expertise in SDM and psychometric measure development. This will establish content validity and ensure wording clarity, to be accessible for all English language requirements.

The new SDM measure will ensure effective evaluation of SDM experiences of people with mental illness. It will be an important step forward in advancing the study and application of SDM in mental health care. It will lay the foundation for further research into the needs of patients and their SNs regarding SDM in mental healthcare.

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Recent evidences suggest that situations of abandonment, neglect and abuse are risks factores for onset of psychopatology in adulthood. This association occus in that traumatic events in the early stages of development and may trigger severe and disabling psychiatric disorders in adults.

The presente study aimed to evaluate the associations between the occurence and severity of chidhood trauma and the development of psychiatric disorders in hospitalized teenagers of the Hospital Psychiatric Vida Londrina/Pr.

The sample was consisted of 14 psychiatric patients, evaluated for severity of psychiatric symtoms by the Back Scale for Suicid Ideation (BSI); Beck Depression Inventory (BDI); Beck Anxiety Inventory (BAI); Back Hopelessness Scale (HAD) and the Barratt Impulsiveness Scale (BIS-11).

In the sample studie, 84% of the teenegers reports that they had some type of childhood trauma. The results indicate that traumas are associated mainly with the development of mood disorders and also with increasin severity of psychiatric symptoms, specially the depressive symptoms, hopelessness, suicidal ideation and impulsivity. Teenagers with emocional neglect, emocional abuse and physical neglect demonstrated having five times more risk of personality disorder. Individuals who suffered physical abuse; sexual abuse and physical neglect presentes at three times more risk of commiting suicid attemps.

These data demonstrate the relevance of trauma childhood as a trigger for psychiatric symptoms.

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Medical studies are known for being difficult and hard. They require a lot of dedication and hard work from students. This takes a toll on their mental health over the years.

Detect signs of anxiety, depression, and stress levels in 5th-year medical students.

This study was cross-sectional through a self-administered pre-established questionnaire for medical students during September and October 2022. We used the General Anxiety Disorder-7 (GAD-7) questionnaire, the Patient Health Questionnaire-9 (PHQ-9) and the Perceived Stress Scale-10 (PSS-10). The satisfaction level with the choice of the medical field as a career was assessed on a scale ranging from 1 to 10.

Our population consisted of 54 5th-year medical students. The average age was 22.94±0.78 and 64.8% were female. All our population were singles. Active smokers represented 9.3% and alcohol consumption was reported by 9.3% of the participants. More than half of the population (51.9%) had a regular leisure activity. Most of the students had no medical history (72.2%) or psychiatric history (94.4%). The mean satisfaction level from choosing the medical field was 7.43±1.84. The mean GAD-7 and PHQ-9 scores were respectively 3.50±3.80 and 4.70±4.42. The PSS-10 score had a mean of 14.07±5.29. Five students (7.4%) presented self-harm thoughts. Students who were less satisfied with their choice of the medical field as a career had significantly higher scores of PHQ-9 (p<0.001), GAD-7 (p=0.004) and PSS-10 (p=.042).

Medical studies are the first step for these young doctors in their professional careers, which presents further psychological stressors. More attention towards the mental health of this population is needed to properly prepare them for their future.

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Globally, burns are responsible for around 11 million injuries and 180 000 burn-related deaths yearly. Unfortunately, 9 of 10 burn injuries and deaths happen in low-and-middle-income countries (LMICs) such as Pakistan. One in three people admitted to hospitals with burn injuries die within three weeks, and survivors face serious lifelong physical, emotional and psychosocial problems. This may result in anxiety, depression, post-traumatic stress disorder, increased mortality and social disintegration. This study aims to evaluate if implementation of a culturally adapted multidisciplinary rehabilitation programme for burn survivors is clinically and cost-effective, sustainable and scalable across Pakistan.

• - To understand lived experiences of burn survivors, families, and other stakeholders including the experience of care and impact of burns To work together with key stakeholders (such as burn survivors, family members) to adapt a culturally appropriate affordable burn rehabilitation programme

• - To undertake social media campaigns to promote burn prevention and risk assessment at communities, workplaces/industries/households; improve first aid; and address burn related stigma

• - To work with policy makers/parliamentarians to develop national guidelines for burns care and prevention in Pakistan

There are 6 work-packages (WPs). WP1 is to co-adapt a culturally appropriate burn care and rehabilitation programme. WP2 will develop and implement national burn registry on WHO’s initiative. WP3 is a cluster randomised controlled trial to determine clinical and cost-effectiveness in Pakistan. WP4 will evaluate social media campaigns for burn prevention and reduce stigma. WP5 involves working with key-stakeholders for burns-related care and policy and WP6 offers sustainable capacity and capability for burns treatment and rehabilitation.

A clinical and cost-effective burn care quality and rehabilitation programme may have a huge potential to save lives and contribute health and socio-economic benefits for patients, families, and the healthcare system in Pakistan. The nation-wide implementation and involvement of burn centres across all provinces offer an excellent opportunity to overcome the problem of burn care access experienced in LMICs.

To date, burns prevention, care and rehabilitation have not received sufficient attention in policy initiatives in Pakistan and other LMICs. This study is an excellent opportunity to evaluate culturally adapted burn care and rehabilitation programmes that can be implemented across LMICs. We will disseminate our findings widely, using a variety of approaches, supported by our stakeholder and patient advisory groups.

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The situation that has been going on in Ukraine for the past six months has led to catastrophic consequences. This forces neuroscientists and, including psychiatrists, to turn to the study of the impact of all these events on the mental health of the population of Ukraine. In 90th of XX Russian psychiatrist Y. A. Alexandrovsky expressed opinion of presence the group of so-called social-stress disorders (SSD) that was determined like psychogenic-actual for most people in definite social, economic and political situation. Most of the people in Ukraine now experience both SSD and post-traumatic stress disorder (PTSD).

Most of the people in Ukraine now experience both SSD and post-traumatic stress disorder (PTSD).

The method of clinic-psychopathological interview with patients who applied out-patient consultation on the chair of psychiatry.

The main changes in psychic state include following behaviors and clinical implications: loss of the value of human life, which is manifested in indifference to death in lowering caution when hazardous situations, willingness to sacrifice lives without any ideals. There is unrestrained lost for pleasure and moral promiscuity, exacerbation of personality typological traits, development of hyperstenic reactions (to self-destructive non-expedient behavior), hypostenic disorders, panic reactions, depression, dissociative and conversive irregularities, loss of communicational plasticity, loss of the ability to adapt to what happens with the preservation prospects of targeted actions, manifestations of cynicism, the tendency to antisocial actions. Patients had complaints on increase anxiety, pessimistic attitudes, existential vacuum, sense of uselessness and loss of perspectives, tendency to irrational perception of reality with including mechanisms of autistic and archaic thinking.

Thus, psychological status of the population of Ukraine is a model of complicated combination of SSD plus PTSD can be considered like a basis which leads to the decreasing of the individual barrier of mental adaptation with the next manifestation of different forms of psychopathological syndromes and needs further in-depth and detailed research.

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Adolescence can be seen as a fundamental stage of life for the construction of the subject, resulting from childhood experiences and decisive for adulthood. It is common stressors to appear during adolescence, due to the lack of necessary resources to deal with a stressful problem or event. In this way, the evaluation of a stressful situation by the adolescent is important, because from it he will develop coping strategies that will help him to deal with the problem.

Stressful life experiences, whether important events or even common annoyances, threaten the adolescent’s well-being, in addition to being linked to mental health and behavior problems, both internalizing ones, such as isolation, somatic complaints and anxiety/depression, as well as externalizing factors such as breaking rules and aggressive behavior. Romantic relationships are related to a major source of stress in the lives of these young people when conflicts, jealousy, aggression and infidelity occur, and have a great impact on the mental health of the individuals involved. Breakups, for example, have been linked to the onset of clinical depression in adolescents.

There are three categories of concern for adolescents: (a) related to achievements, such as success in school or opportunity for success in the future; (b) relationships with colleagues or family members; and (c) social problems such as the environment, poverty and unemployment.

To identify and describe stressful life events in adolescents from public schools in a poor community in Brazil.

The study included 64 adolescents, boys (51.56%) and girls (48.43%), aged between 12 and 16 years old (average 13.76%). The Adolescent Perceived Events Scale (APES) was used, which consists of 90 items that correspond to events that may occur in the adolescent’s daily life.

The most significant stressors for the adolescents in this study were those dealing with the death of close people, such as a friend (100%), a family member (96.29%) and a relative (94.73%). Also appearing as major stressors were “plans that did not work” (91.89%), use of alcohol or drugs by family members (87.5%), loss of a job by parents (75%), imprisonment of a family member (75%), fights with boyfriend or girlfriend (86.66%), breakup (75%) and concern about their own appearance (76.52%).

Events referring to interpersonal relationships were considered the greatest stressors, with percentages above 80%. The present study contributed to the understanding of adolescents’ perceptions of their life events. In this way, we can understand the relationship between stressors and the coping strategies. Furthermore, it allows the proposition of preventive intervention strategies in the school context.

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The study period to become a medical professional is notoriously stressful This label can be attributed to various factors like long tedious training, social expectations, long work hours, high liability, sleep deprivation, and a constant lack of time to relaxin this vulnerable area, physical appearance, either weight loss or obesity, can affect the mental health of these young people.

To determine the role of body mass index (BMI) on the levels of perceived stress in medical students.

Our study was descriptive and analytical cross-sectional, carried out with medical students in the faculty of medicine of sfax (Tunisia) during October 2022.

An anonymous survey was asked to the students.

Data collection was done by a self-administered questionnaire via Google Forms administered in the students’ Facebook groups. The questionnaire was composed of a part for the collection of socio-demographic data and a psychometric scale:

• - Cohen’s Perceived Stress Scale (PSS) to determine the level of stress

A total of 95 responses was collected.The average age of our sample was 25.8±3.4 with female predominance (78,9%).

The half of the population (53,7%) were residents in medicine.

The majority of them (88,4%) had an average socio-economic level and singles (83,2%) .

81,1% had a stressor related to studies in 50,5%,to family in 40 % and financial in 9,5%.

Tobacco consumption were reported by 14,7 % .

A psychiatric history was reported by 17.9% of the students, 76.5% of whom are anxiety disorders.

27.4% tried to control their weight. Several methods of weight control were used, the most frequent (65.4%) was diet, none resorted to laxatives and 8.4% consulted a nutritionist.

Almost half of the population (57,9%) slept between 5 and 7 hours.

The average body mass index was 23.64 kg/m2 (SD=3.53).

According to PSS scores, 21.1% of students had severe level of stress, 69.5% had moderate stress level while 9.5% had low level of stress.

Those followed in psychiatry had a higher level of stress (p<10-3), especially those with anxiety disorder (p=0,02).

The students pressed for weight control were more stressed than their peers.

The levels of stress were higher among underweight students (BMI < 18.5) and overweight students (BMI >25) without significantly correlations.

The current study revealed that medical students, especially underweight or overweight students, are more susceptible to develop stress symptoms,that is why psychic support must be available on their university.

None Declared

When we think of multiple sclerosis (MS), we usually talk about the sensory and motor symptoms of the disease and their impact on the functioning of the individual affected. However, this disability can lead to a wide range of symptoms, including psychological and cognitive manifestations that also have a significant impact on the quality of life of patients

To estimate the incidence of psychiatric disorders in patients with MS.

A cross-sectional descriptive study that interested MS patients referred to the occupational pathology consultation of the Charles Nicolle Hospital, during the period from July 1, 2020, to September 30, 2022. The data collected concerned the characteristics of the disease. The detection of psychiatric disorders was studied through a validated self-questionnaire GHQ-12 (General Health Questionnaire).

The study population consisted of 26 cases. The average age was 38 ± 9 years. A predominance of females was noted in 77% of cases. Eight patients (31%) were smokers. Nine cases (47%) had a relapsing-remitting form and six cases (32%) had a primary progressive form. All patients were on disease-modifying therapy. The average duration of the disease was 6 ± 3 years. The average duration of work during the illness was 4 years [one year-12 years]. The average duration of work stoppage in the last 12 months of activity was 63 days [2-240 days], of which 54% was long-term sick leave. The mean GHQ-12 score was 4.38 [0-10]. Twenty patients (77%) had psychological disorders.

This study shows the high frequency of psychiatric disorders in our MS patients. The role of the neuropsychologist is therefore often crucial in the care of these patients.

None Declared

The COVID-19 pandemic has significantly impacted mental health services, with the literature reporting an increase in the incidence of psychiatric admissions.

The aim of this study was to assess the impact of the pandemic on clinical presentations, characteristics of admission and incidents occurring in three acute inpatient mental health facilities in the UK.

This was a retrospective study comparing data from the first and third UK lockdown to the five years prior to the pandemic. Data was acquired from electronic clinical records and addressed two acute psychiatric inpatient wards and one psychiatric intensive care unit. Key outcomes of comparison were clinical presentations, number of admissions, length of hospital stay, number of incidents and characteristics of incidents.

Compared to the previous 5 years, a higher number of incidents characterized by violence and aggression were reported during the first (56.8% vs 44.3%, x2=16.56, df=1, p<0.001) and third lockdown (100.0% vs 86.2%, x2=36.40, df=1, p<0.001). An increase in non-psychotic disorders was observed in the first lockdown (20.0% vs 13.1%, x2=4.76, df=1, p=0.029), whilst increased first episode psychosis (19.7% vs 11.3%, x2=8.1, df=1, p=0.004) and schizophrenia spectrum disorders (74.4% vs 57.2%, x2= 7.6, df=1, p=0.006) were diagnosed during the third lockdown. There were no significant changes in the diagnosis of mood disorders in both lockdowns compared to previously. The median length of inpatient stay significantly reduced during the first lockdown (28 days vs 36 days, x2= 7.66, df=1, p=0.006).

Increased inpatient incidents may be explained by the impact of the pandemic on staffing levels and resources, combined with increased emotional distress amongst patients in the face of uncertainty. The pandemic may have increased substance misuse potentially linked with the increased incidence of first episode psychosis.

S. Bonaccorso: None Declared, O. Ajnakina: None Declared, A. Ricciardi: None Declared, S. Ouabbou: None Declared, J. Wilson: None Declared, C. Theleritis: None Declared, M. Badhan: None Declared, A. Metastasio: None Declared, N. Stewart: None Declared, M. Barczyck: None Declared, F. Johansson: None Declared, T. Tharmaraja: None Declared, F. Schifano Speakers bureau of: Prof. Fabrizio Schifano is a member of the European Medical Agency

Humanization in Mental Health is a concept that treat to conceal in the last decades the quality, efficiency and safety of care of complex diseases and conditions with individual values, needs and preferences and involves the patient and society in the decision-making priority.

to stablish and evaluate the priorities of different groups of interest in the development of a new humanization plan for mental health

During 2022 a Humanization plan for the Spanish region of Castilla y Leon (2.400.000 habs) was developed with a Delphi model. Participants included 36 stakeholders including mental health services, administration, social services, associations, patients and families. They stablished 32 objectives distributed in 7 strategic lines: 1. “People First” (Rights, Autonomy and Information); 2. “From People to Services” (Participation of users in mental heal services); 3. “Person-Centered-Assistance” 4. “Processes sensible to change” (reduction of coercion); 5. “Human ambient” (Improvement of units, psychosocial interventions). 6. Innovation, training and climate (not evaluated here). 7. “People without marks” (battle against stigma).

Priorities in the lines were stablished by representatives from mental health and other healthcare professionals, social and educational stakeholders, scientific societies, patients and families. After agreeing to participate in the process, they had to answer an online survey. For each line, they have to score it from 0 to 10.

500 subjects participated (38.6% Healthcare workers, 14% Mental Health Care users, 9.8% Social Services, 8.8% Associations, 7.8% Drug Services 6% Management of Health System, 5.8% Education Services, 3.8 Justice). Humanization was the most appreciated plan within the mental health plan 2022-2026 in Castilla y Leon (8.81±1.43).

The Highest priority score was given to the Rights (8.68 + 1.54), Information (8.44 + 1.60) and Stigma (8.43 + 1.89) lines and the lowest were the evaluation of satisfaction (7.62 + 1.90) and Reduction of Coercion (7.29 + 2.12). Differences were found between groups. Scores in Rights and Autonomy (F:3.474; p<0.001) were highest in the Associations (9.32 +1.01) and lowest in the Justice group (7.68 + 1.67). In the information line the highest score (F:2.431; p=0,014) was in the Education Services (9.03 +0,94) compared to Scientific Societies (7,65 + 2,13). Highest score for Participation of Users (F:2,968; p=0,003) was in Social Services (8.76 +1.48) compared to Justice (7.47 +1.95). There were differences in the coercion reduction line (F:2.165; p=0,029) but no pairwise differences were found

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Humanization approaches are well appreciated by different stakeholders. Priorities in our region start with rights, information and integration and mental health users in the health system and society

None Declared

A 15-day compulsory rotatory rural psychiatry posting was introduced into the MD psychiatry curriculum at NIMHANS to orient trainees to the functioning of community mental health services.

To capture the views and subjective experiences of the 32 residents posted in rural psychiatry services under District Mental Health Program (DMHP) using qualitative interviews.

In-depth qualitative interviews were conducted to understand the residents’ experience in various aspects of the community psychiatry posting. The interviews were audiotaped and later, transcribed. Thematic analysis of transcripts was done.

The analyzed data was converted into 41 codes and 12 themes. The themes related to positive experiences were good clinical exposure and skills to practice in low-resource settings, focus on preventive mental health care, enhanced communication, administration, leadership skills, and increased empathy. After training, the residents also reported gaining insights into the attitude of policy-makers and increased interest and confidence to practice in a rural setting. The themes highlighting the perceived challenges ranged from personal reasons, such as food or transportation, to professional ones like stigma, limited resources, a burdensome amount of paperwork, limited availability of psychotropics, and communication barriers. Residents who expressed interest in practicing rural psychiatry in the future cited a good wage, higher levels of self-satisfaction, confidence, and an emotional connection to their native place as motivating factors. Those who did not want to join DMHP had concerns such as not having adequate skills for working in a low resource setting, compromised basic needs, superiors not being sensitive to mental health issues, additional non-psychiatric work, job instability and lack of academic and research opportunities.

The posting to nearby DMHP centers was feasible and contributed positively to the training experience of the residents. Positive experiences, challenges, and other lessons learned by these residents could help them plan their career in rural psychiatry. It was found that both the residents and the DMHP team contributed to each other’s growth. This posting was likely to boost residents’ confidence to work in rural settings and could also aid in easing the crisis of lack of community-based mental health experts. The authors advocate for the national implementation of such rural psychiatry posting.

None Declared