Exposure to organic solvents (SO) is a significant occupational hazard in industrial settings. This can lead to neurobehavioural and physical effects that can affect the quality of life of workers

To assess, using a validated questionnaire, the quality of life of workers exposed to SO.

Cross-sectional descriptive study conducted at the occupational medicine department of the Charles Nicolle Hospital in Tunis, which interested patients exposed to SO who had consulted for a medical opinion on fitness for duty during the period from January 1, 2017 to August 31, 2022. The data collection was carried out by a telephone call using the SF12 questionnaire. Socio-demographic and medical data were completed from medical records.

We identified 51 workers exposed to OS. Thirty-three employees agreed to answer the SF12 questionnaire, for a response rate of 65%. The average age was 44 8 years with a clear male predominance of 75%. The most represented sectors of activity were the automobile industry (34%), followed by the leather and footwear industry (15%) and the plastics industry (12%). The jobs most exposed to SO were manual workers (54%) and painters (9%). The median occupational seniority was 15[10; 23] years. Comorbidities were observed in 72% of employees. The average physical composite score was 48%. The average mental composite score was 49%. The average overall score was 49%. Average quality of life (overall SF12 score above 50) was noted in 60% of the population. Moderate disability (overall SF12 score between 30 and 39) was found in 18% of respondents. Twenty-one percent of workers had a severe disability (overall SF12 score below 30).

In addition to socio-professional conditions, exposure to SO may be implicated in altering the quality of life of exposed workers. This implies the need to strengthen preventive measures in order to preserve the mental and physical health of these workers.

None Declared

Methadone has been available for about half a century. It is traditionally known for its role in the withdrawal and maintenance of patients addicted to heroin or other opioids.

A large body of evidence has identified a number of advantages of methadone over other opioids in the treatment of pain, including its agonist action at μ- and δ-opioid receptors, its N-methyl-D-aspartate (NMDA) antagonist activity, and the ability to inhibit monoamine reuptake, hence its interest in the treatment of cancer pain and, more recently, neuropathic pain and non-cancer pain.

Methadone proves to be a treatment adapted to the management of complex painful situations, resistant to other opioids. It sometimes makes it possible to postpone an invasive act, sedation for refractory symptoms while maintaining the patient’s autonomy. Its use in many countries and feedback from our colleagues agree with our observations. It is an effective molecule as an analgesic on different types of pain, including post-surgical pain, cancer-related pain or nociceptive pain

explain the role of methadone in the treatment of chronic and acute pain.

We will explain through a clinical case the role of methadone in the treatment of chronic and acute pain. The patient was a 35-year-old nurse, married with 3 children, with problematic use of codeine and morphine for chronic pain due to endometriosis. She was put on 20mg/d of methadone with good clinical improvement.

We reported the clinical case of a patient followed for endometriosis and that she presents with acute and chronic pain during and outside of menstruation. The patient was treated with (Danazol) and analgesics to manage her pain. She was initially put on level 1 analgesics: paracetamol and NSAIDs, then on level 2 analgesics, in particular codeine at a rate of 200 mg/day, without any improvement. Faced with this state, the patient was put on morphine with a gradual increase in doses on her own initiative up to 30mg/d. The patient tried to stop her morphine consumption on several occasions without succeeding. The patient was put on methadone to treat both her pain and her addiction to morphine, methadone significantly reduced her pain within a few days.

Methadone proves to be a treatment adapted to the management of complex painful situations, resistant to other opioids. It sometimes makes it possible to postpone an invasive act, sedation for refractory symptoms while maintaining the patient’s autonomy. Its use in many countries and feedback from our colleagues agree with our observations. It is an effective molecule as an analgesic on different types of pain, including post-surgical pain, cancer-related pain or nociceptive pain.

None Declared

Chronic back pain is one of the leading causes of disability and treatment is often ineffective. Approximately 85% of cases are primary, for which the peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury.Studies suggest that an excessively negative orientation towards pain (pain catastrophism) and fear of movement/(re)injury (kinesiophobia) are important in the aetiology of chronic low back pain and associated disability.

The aim is to identify the psychopatological profile (including levels of movement phobia and catastrophic thinking) in patients with chronic low back pain who participate in a multidisciplinary group Comprehensive Care Program for Patients with Chronic Pain (PAINDOC) in the Pain Unit of the Hospital Clínic i Provincial de Barcelona.

A cross-sectional descriptive study of 75 patients aged between 28 and 68 years who participate in the treatment is carried out. A clinical interview was carried out, anxiety and depression symptoms were assessed with thHospital Anxiety and Depression Scale (HADS), Kinesiophobia was evaluated with the Tampa Scale Kinesiophobia (TSK-11SV) and catastrophism with the Pain Catastrophizing Scale (PCS).

The results show that the patients presented a high level of catastrophic thinking, especially in the subgroup of women with a longer duration of pain.Movement phobia was observed in 27% of patients, and correlated with feelings of depression and anxiety.

Catastrophism is a multidimensional psychological construct that encompasses elements such as rumination, magnification, and incapacity.Catastrophic thinking in relation to pain is a risk factor for chronic pain. Kinesiophobia is based on the fear avoidance model and perpetuates a cycle of heightened fear of pain, disability, and depression. These constructs can be very useful to evaluate in patients to reduce the intensity of pain, the associated emotional suffering and reduce the probability that the pain will become chronic.

None Declared

Patients with Borderline Personality Disorder (BPD) require a significant amount of time and effort on the part of general practitioners and psychiatrists, resulting in longer visits and complex medical records, with a poor resolution of both physical and mental symptoms.

These patients are likely to express feelings of anger and violence, compared to other patients which makes it difficult to deal with them.

To determine attitudes toward patients with BPD among psychiatry and family medicine residents in Tunisia. To understand in addition the challenges that these professionals encounter in their everyday practice

An online anonymous questionnaires was distributed through social networks to psychiatry residents and family medicine resident.

The attitudes of health professionals towards people with BPD was used to assess clinicians’ attitudes towards people with BPD.

Thirty three clinicians were in the study. A high proportion of respondents (81.8%) were females .The age of the participants ranged from 25 to 34 years, with an average age of 28 years and 3 months (SD = 2.23).In our study 34% reported that they often see patients with borderline personality .The half of the participants (51.5%) reported a feeling being on guard when meeting borderlines while 36.4% were empathetic and neutral. The feeling of anger and frustration was reported with 12.1 % of the participants.

The most frequent cause of these feelings was the difficulty of taking care of patients with BPD.

The majority of the participants (51.5%) reported avoiding working with them. However, only 39.4% reported asking a colleague to replace them in their follow-up.

The results of Attitudes of health professionals towards people with BPD Scale indicate that clinicians generally present a positive attitude towards patient BPD with a mean score 94.94(SD=18.60)

Working with patients with BPD can be challenging. Professionals’ attitude can create obstacles to effective communication and successful treatment.

Therefore, all clinicians should receive more specific training to be able to deal with this condition.

None Declared

We present the case of a 43 year-old woman that, following the sudden death of his brother in 2015, begins with symptoms of anxiety, irritability and emotional instability, with a tendency to social isolation. Thereafter, she starts the development of persecutory delusions focused on the work and family environment that evolve into inappropriate behaviors to the point of abandoning her professional life.

(1) We will carry out a complete review about persecutory delusions and its relationship with affective disorders, based on the severity of our patient’s case.

(2) We will study the different lines of treatment in delusional disorder (DD) and its course and prognosis in relation to the intervention performed.

A review of the patient’s history will be conducted, taking into account her biography, clinical evolution and response to the treatments received.

Likewise, a bibliographic review of the available scientific literature in relation to DD treatment strategies will be carried out.

(1) DD is more common in middle-aged women. People who tend to be socially isolated are more likely to develop DD.

(2) Acute onset, in young women with identifiable precipitating factors, suggests a better prognosis.

(3) In the long term, 50% of patients recover and a further 20% experience some improvement.

(4) The combination of antipsychotic medications and psychological therapies such as cognitive behavioral therapy (CBT) is fundamental in the management of DD patients.

The prognosis for patients with DD varies depending on various factors, including the type and severity of the delusional ideas, and their own life circumstances. It is often possible to eliminate the behavioral alterations derived from the DD, allowing the patient to function normally. However, delusions often persist and become encapsulated.

None Declared

At preschool age, children develop all the speech functions, including the planning function, which allows them to think through the future speech statement. Researchers find a link between impaired ability for speech forecasting and anxiety disorders, as well as emotional disorders.

identifying the specifics of speech forecasting in preschool children with emotional disorders.

the study involved 48 children: 24 children of preschool age without developmental disorders, 24 children of preschool age with emotional disorders. Empirical examination was carried out using the “Prognostic stories” technique.

Children with autism spectrum disorders often have speech disorders, speech may manifest stereotypes in speech, the appearance of echolalia, many children do not use speech for communication. Among the functional characteristics of forecasting, the cognitive forecasting function has a statistically significant difference (t=4.165<.001). Children with autism spectrum disorders, having difficulties in social interaction, can choose ways of action that are not suitable for the existing situation. Children’s forecasts are usually short-term, invariant, generalized and minimally verbalized.

Indicators of speech-communicative function confirm the presence of difficulties in children with emotional disorders in the ability to verbalize information, however, they have a realistic vision of the future and are focused on following the social norm. This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program.

None Declared

The degree of success and effectiveness of the child’s socialization largely depends on the timely formation of social emotions, the ability to understand the emotional states of the participants in the interaction and manage their emotions.

Studying the features of understanding the emotional states of peers and adults by children of preschool age with disabilities.

The study involved 227 children aged 5-7 attending educational institutions: 95 children without developmental disorders; 73 children with severe speech disorders; 9 children with motor disorders; 25 children with visual impairment (strabismus, amblyopia, astigmatism); 15 children with hearing impairment (3rd and 4th degree sensorineural hearing loss); 10 children with autism spectrum disorder. The “Emotional Faces” method (Semago) and the method of studying the child’s understanding of tasks in situations of interaction (Veraksa) were used.

Tasks for the categorization of emotional states cause difficulties in children with speech disorders, since they require a certain mastery of vocabulary for the designation of emotional states. As a result of limited communication in children, there is a lack of understanding of the meaning, causes and motives of the actions of other people, as well as the consequences of their actions, their impact on others.

Preschool children with motor disabilities are inferior to peers without developmental disabilities in accurate verbalization of emotional states, manifested in a primitive description of emotions.

Visually impaired preschool children do not have sufficiently clear ideas about socially acceptable actions in communication situations, about ways of expressing relationships with peers and adults.

Children with hearing impairment better understand the emotional states of their peers than the states of adults, but they do not know how to show their attitude towards their peers. Difficulties in verbalizing emotions are observed.

Children with autism spectrum disorder experience significant difficulties in recognizing various situations of interaction, isolating tasks and requirements set by adults in these situations; children practically did not try to depict an emotion, having difficulty in differentiating it.

The research confirmed the assumption that children with disabilities have significant difficulties in differentiating similar emotions, they do not accurately determine the emotional state of their peers and people around them. This paper has been supported by the Kazan Federal University Strategic Academic Leadership Program.

None Declared

The Kessler Psychological Distress Scale (K6) is a psychometrically robust measure of psychological distress for adult populations, the most commonly used screening measure in the general population. It is used in epidemiological surveys globally, including the World Health Organization and World Mental Health Survey. Recently, there has been a research interest in examining the psychometric properties of the K6 in college students’ populations.

To examine the reliability, validity and factor structure of the Arabic adaptation K6 in Kuwaiti college students.

The participants were 1402 individuals (509 males, 893 females) Kuwait University undergraduates, aged 18–35 years-old mean age = 21.50 ± 4.87. The Arabic versions of The Kessler Psychological Distress Scale (K6), The Depression Anxiety Stress Scales DASS-42, Beck Depression Inventory-II, and Beck Anxiety Inventory –BAI were administered to participants including demographics. The internal consistency reliability, factor structure, and convergent validity of the (K6) with DASS-42, BDI-II, & BAI were computed.

Internal consistency was satisfactory for the K6 (Cronbach’s alpha =0.80 for males & 0.79 for females). The results revealed significant gender differences in distress with a favor for females (f=8.95, p. >.003). Principal component analyses (PCA) showed that a K6 one -component solution explains %61.51 of the total variance for males and %57.23 for females. The k6 correlates with DASS Stress (r=.76), DASS Depression (r=.57), DASS Anxiety (r=0.76), BAI (r=.73) and BDI-II (r=46).

The K6 provides satisfactory validation, and can be recommended as a measure of distress among Arab college students.

None Declared

Schizotypal disorder is conceptualized as a stable personality pathology (Cluster A) and as a latent manifestation of schizophrenia. It can be understood as an attenuated form of psychosis or high-risk mental state, which may precede the onset of schizophrenia or represent a more stable form of psychopathology that doesn’t necessarily progress to psychosis.

To exemplify the continuum of psychosis

Review of scientific literature based on a relevant clinical case.

39-year-old male living with his parents. He started studying philosophy. He is a regular cannabis user and has an aunt with schizophrenia. He’s admitted to psychiatry for behavioral disturbance in public. He refers to having been hearing a beeping noise in his street for months, what he interprets as a possible way of being watched due to his past ideology. Without specifying who and why, he sometimes shouts “until it bursts” to stop the noise and he thinks that his neighbours alerted the police about his behavior. During the interview he alludes to Milgram’s experiment, saying that throughout history there have been crimes against humanity and those who pointed them out were labeled “crazy”. His father refers that he has always been “strange” and with certain extravagant revolutionary ideas and thoughts. He doesn’t maintain social relationships and dedicates himself to reading and writing.

It’s important to understand psychosis as a continuum to advance the understanding of etiology, pathophysiology and resilience of psychotic disorders and to develop strategies for prevention and early intervention

None Declared

More traditional lecture-based teaching has ruled medicine for generations. However, with the advancement of technology, a more modern approach to medical education can be developed. Podcasts are recordings, unlimited by time and space, that can act as extremely effective educational tools. Podcasts are a new approach that have the potential to transform the way medicine is taught.

This research project discusses the process of creating a podcast series for medical students based around the topic of personality theories. The aim of the project was not only to give medical students a more efficient and accessible way to learn, but also to tackle an undertaught topic in psychiatry. The podcast series I have developed explores the history of personality psychology, beginning with Greek philosopher Hippocrates and his theory of the 4 temperaments and travelling all the way up to the theories of the 20th century, ending the series by discussing the most modern approach to assessing personality; trait theory. The topic of personality theories is essential psychology to grasp in order to fully comprehend psychiatric disorders learnt later in medical school.

The process of creating educational podcasts did not come without its challenges. The vastness and complexity of information I came across was difficult and time consuming to narrow down and pick the most important points for medical students to understand. The biggest challenge I had was lack of clinical experience in psychiatry. Being involved in creating educational resources as a medical student, with little to no clinical experience in psychiatry, meant textbooks and primary literature were my key sources of information. However, I was aware this way of learning psychiatry was limiting; learning from textbooks alone may give a skewed picture of psychiatric conditions that can only be gained by seeing and learning from patients in the clinical environment. It allowed me to reflect on the use of online clinical videos in replacement of experiencing psychiatric placements.

The Podcasts themselves were crafted based on information from the most recent podcast research. They were made within the ideal timing and style to maintain audience engagement and allow listeners to process and retain new knowledge and make the most out of the learning style.

They utilised Kolb’s learning style and allowed listeners to take an active role in the processing of new information by asking several questions throughout each episode. This technique especially gave learners opportunity to reflect on their own bias and change their perception about new concepts they were presented with. By the end of the production time, I realised the podcasts needed constant summaries in order to be successful learning materials.

None Declared

Intimate partner violence (IPV) is broadly defined as physical, sexual, or psychological harm inflicted by a current or former romantic partner or spouse. Unfortunately, even nowadays, the prevalence rates of IPV victimization are still very high, with over one third of women reporting any contact sexual violence, physical violence, and/or stalking and nearly half having psychological aggression in their lifetime. Amongst a complex network of risk factors for IPV, Personality disorders (PD) are one of the most researched. Defined as enduring patterns of inner experiences and behaviors, PD play a significant role in IPV, causing perpetrators to recidivate and victims of IPV to stay in violent relationships.

A case based approach is used to illustrate the association between Dependent Personality Disorder and Intimate Partner Violence

Case Report and Brief Literature review

Case: We present a case of a 65-year-old woman, long term followed by psychiatry for anxiety and depression symptoms, built upon a personality with dependent traits. The patient has been victim of intimate partner violence since her marriage, more than 40 years ago, generating significant psychopathology, functional impairment and several suicidal attempts over the years. Nonetheless, the patient feels emotionally attached and has pity for her husband. Despite this abuse had been already reported, the patient has been unable to act on the complaint, perpetuating this situatuon over time. The insight is totally preserved since the victim has full conscience of the causality between perpetrator cumulative abuse and her psychological and physical suffering. This case supports research in this area which had found that individuals with high levels of dependent PD traits tend to have higher ratings of relationship satisfaction and see their relationship in a more positive light, causing them to downplay the IPV they experience.

The prevalence of IPV poses a serious public health concern, particularly given the increased risk of physical and mental health problems that have been linked to IPV, such as chronic pain, depression, post traumatic stress disorder, substance use, and suicidal ideation, as well as a host of other negative outcomes. Individuals with high levels of dependent PD traits are prone to victimization, clinicians should be alert.

None Declared

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder is a severe disorder of emotional regulation. In people with BPD, mood swings are extreme, relationships are uncertain, and emotions are difficult to control, suicide and self-destructive behaviors are extremely common. medical treatment can certainly reduce the symptoms and suffering of people with BPD, but it is still not enough. The treatment is mainly based on psychotherapy especially Dialectical behavior therapy (DBT) focuses on the concept of mindfulness, or paying attention to the present emotion.

To assess the current level of evidence for mindfulness in BPD.

a systematic review was performed using the database PubMed / Medline, using the following keywords: “MCBT”; “DBT”; “Mindfulness Therapy”;” BPD”; “Borderline personality”.

Research shows that the mindfulness therapy approach teaches skills for controlling intense emotions and reducing self-destructive behaviors. Decentering appears to play a crucial role in the treatment as a primary mechanism of action in this therapy.

results suggest that the Mindfulness therapy is a main component for BPD treatment.

None Declared

Borderline personality disorder (BPD) has a significant presence in outpatient psychiatric practice worldwide, but data on the clinical features of patients with BPD in Russia are limited. Clinicians experience a number of difficulties in diagnosing BPD, which is also due to the high comorbidity of BPD with other mental disorders (affective, anxiety, other personality and addictive disorders).

The aim of this pilot study was to investigate clinical characteristics of mental health care for patients с BPD in real clinical practice in community in Saint-Petersburg, Russia.

Fifty patients (72% female; n=36; mean age 22.4±4.3) who were treated in an outpatient community care were included in the study. Diagnosis was made according to the ICD-10 criteria (F60.31), as it does in clinical practice in Russia. Research methods included a clinical-catamnestic method.

The age of onset of BPD symptoms was 14.9±2.7. It was found that 50% of patients had previously received inpatient (20%, n=10) and outpatient (30%, n=15) psychiatric care unrelated to the current mental condition, that is, not due to the BPD. 16% of patients (n=8) referred for the first time for psychiatric care in adolescence. The vast majority of patients (86%; n=43) were not diagnosed with BPD when they first consulted a psychiatrist. Prior to the diagnosis of BPD, patients were diagnosed with mental disorders due to organic brain injury (4%), affective disorders (44%), schizophrenia spectrum disorders (12%), anxiety disorders (20%) and other personality disorders (6%). On average, it took 7.5±4.0 years from the date of first psychiatric assessment before the diagnosis of BPD was confirmed. At the time of inclusion in the study, patients were diagnosed with the following comorbid mental health conditions: affective disorders (12%), anxiety disorders (6%), eating disorders (4%), and addictive disorders (2%).

The hypodiagnosis of BPD in the early stages of the disorder has been identified, making it challenging to obtain high quality mental health care in a timely manner. The frequent comorbidity between BPD and other mental disorders has been confirmed. The study demonstrates the relevance of introducing programs (including education) to improve the diagnosis and study of comorbidity of BPD in real clinical practice. The pilot study results provide the basis for a project to investigate approaches to differential diagnosis and evaluation of treatment strategies for patients with BPD.

None Declared

Public servants, because of the nature of their work, are under tremendous pressure. Hence the need to study the dominant personality traits within this sample.

Demonstrate the domination of certain personality dimensions over others in this population.

The aim of this research is to study the five major personality traits in a sample of officials in the Rabat-Sale-Kenitra Region, Morocco.

This is a cross-sectional epidemiological study that involved 387 individuals, including 55.8% (n=216) Male and 44.2% (n=171) Female with an average age of 32.75± 9.79. The personality traits were assessed using the Big Five test.

The results show that, 76.74% of our study subjects have a high score of Agreeableness, while 23.26% have a low score. 59.69% of our sample has a high score in Extravesion, while 40.31% have a low one. Slight increase in the percentage that has a high score in Neurosis compared to those that have a low score with 51.94% and 48.06%. 78.29% of our sample have a high Consciousness score, while 21.71% have a low one. Concerning Openness, 79.84% of the participants have a high score and only 20.16 have a low score.

This study sample is characterized by the dominance of three main traits, Agreeableness, Consciousness and Openness. Moreover, this study has shed light on the fact that the Neurosis trait is dominant in almost half of our sample. However, considering this study concerned only one region, it would be interesting to widen the geography of the survey to acquire more exhaustive results.

None Declared

We present the case of a 22-year-old patient who has been followed up in a daytime hospital for personality disorders since June 2022. Of note is the presence of multiple personalities (in total of more than 20 have been identified), each of which has distinct physical and psychological characteristics.

The objective is to present a clinical case of dissociative identity disorder and to review the existence of scientific evidence supporting this diagnosis.

Literature review of scientific papers over the last years and classic textbooks on the issue. We included references in English and Spanish languages.

Numerous studies support that dissociative disorders are the result of psychological traumas that generally begin in childhood. This is a difficult category to diagnose, since they present symptoms that also appear in other disorders such as those of the schizophrenic spectrum.

One or more dissociative parts of the subject’s personality avoid the traumatic memories while others become fixed to these traumatic experiences and manifest symptoms. In the case of our patient, there are dissociative episodes with subsequent amnesia and auditory, visual and olfactory hallucinations, as well as impulsive behaviors in the form of self-injury and a flattened affect, with significant emotional distancing.

• - The prevalence of dissociative identity disorder is higher than traditionally thought.

• - Some theories develop how trauma essentially produces a degree of dissociation of the psychobiological systems that constitute the subject’s personality.

None Declared

The relationship between narcissism and burnout has been explored in the literature with somewhat inconsistent findings. Though most studies have found a positive correlation between Narcissism and Burnout, some have failed to establish a significant link between the two, while others have even reported a protective role of narcissism against burnout.

In our previous work regarding the link between perfectionism and student burnout, we found that when using the Big Three model of Perfectionism, Narcissistic Perfectionism had only a weak connection to burnout, requiring full mediation by low-self compassion.

We hypothesized that this might be due to an exaggerated sense of Academic Efficacy in Narcissistic Perfectionists, which would compensate for some of the emotional exhaustion and depersonalization brought upon by their efforts to gain the admiration of others.

To investigate the link between Narcissistic Perfectionism and Academic Efficacy, and its impact on burnout levels.

A sample of 1080 students from healthcare-related courses (80,7% females; mean age=21.13±3.023; range: 17-41) filled in an online questionnaire including, among others, the Portuguese Version of BIG3-SF and MBI-SS. Correlational analysis was performed.

Contrary to our initial theory, Narcissistic Perfectionism did not significantly correlate with Academic Efficacy (r=0.011, p=0.728), although it had significant correlations with the other burnout dimensions and total burnout score.

This work disproved our initial hypothesis, suggesting that narcissistic perfectionism may be associated with other nefarious dimensions that cancel out the effects of grandiosity and inflated self-esteem on the perception of academic efficacy. This negative finding could possibly be further explored by using a psychometric instrument that differentiates between maladaptive and adaptive facets of narcissism.

None Declared

Autism spectrum disorder is a neurodevelopmental disorder characterized by persistent deficit in communication and social interaction associated with repetitive, restricted interests, behaviors or activities. Regardless long-term care, sequelae may remain present particularly in cognitive patterns, social interactions and adaptive reactions, leading to personality disorder in adulthood.

In this study we aimed to explore personnality disorder comorbid with autism spectrum disorder .

Our study was based on the PubMed interface and adapted for 2 databases: Science Direct and Google Scholar using the following combination ( autism spectrum disorder [MeSH terms]) AND (personality disorder [MeSH terms]) covering the period from 2013 to 2022.

We initially reviewed 13 articles. At the end of the literature selection process, two articles were included.

The prevalence of personality disorders with ASD was estimated around 35%.

The personality disorders evoked mainly responded to cluster C associating an obsessive-compulsive and avoidant personality in respectively 32% and 25%.

Cluster A personality disorders, in particular schizoid personality, were found in 21% with a female.

Concerning cluster B, borderline personality disorder was the most frequent because of different symptoms overlapping . In fact, the prevalence of borderline personality disorder in ASD was 4% . Meanwhile the prevalence of ASD in borderline personality disorder was 3%.

Apart from other neurodevelopmental pathologies, ASD can be comorbid with personality disorder. However, the neurocognitive particularities of ASD reveal clinical manifestations similar to those found in personality disorders. Therefore, additional research using large sample sizes and validated diagnostic tools taking into account the specificities of this population remain necessary.

None Declared

Dissociative identity disorder (DID) also referred as multiple personality disorder is a chronic post-traumatic condition. It is characterized according to DSM-5 by “disruption of identity characterized by two or more distinct personality states”, with “marked discontinuity in sense of self… accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.”

Here, we present a case of a 33-year-old Caucasian female with no psychiatric history until 2 years ago, privately. The patient is admitted to the Psychiatry Service due to worsening. During admission, consultations are made to the Neurology Service and the Neurophysiology Service, who request an electroencephalogram, an MRI and a brain scan, resulting in normality.

After discharge, she returns home with her parents, and the crisis become more frequent and of longer duration. She acknowledges that during these periods she is dominated by her alternate personality, which she is unaware of until her family informs her. This personality is a demon, who verbally assaults and even physically threatens her surroundings, and can hardly be controlled by the prayers of her family.

Despite psychopharmacological treatment, as well as the cognitive-behavioral therapy carried out by the patient for more than two years, there was no improvement. Once she comes to the consultation, it is decided to carry out a therapy guided by the central Rogerian attitudes, originating a process of empathic resonance of the therapist, which influences the experience of the patient. Three main interventions are carried out, the awareness of the disease, the regulation of the intensity of this experience, to maintain the attention and the exploration of what guides the change. After carrying out this intervention, the patient is currently asymptomatic.

Currently, there are not evidence-based treatment guidelines. The most common approach is individual psychodynamic psychotherapy according to practice-based guidelines initiated by the International Society for the Study of Trauma and Dissociation.

To handle the present case, we used a model with two pillars, the patient’s commitment and the investigation of microprocesses within a process of experiential exploration, in which the therapist is a facilitator of reflective attention and experimental awareness.

The torpid evolution suffered by the patient, with little clinical improvement to the interventions carried out, and the absence of evidence on the treatment, led to a therapeutic approach focused on the empathic resonance process of the therapist, with good results.

None Declared

Borderline personality disorder (BPD) is a common and serious mental disorder. Its prevalence is estimated to be around 20% among psychiatry inpatients and 11% in Psychiatric Outpatients. Patients with BPD present a wide range of psychopathological symptoms such as affective instability, impulsivity, interpersonal problems, psychotic-like symptoms and self-destructive behaviour. BPD also occurs as comorbid illness with number of other Psychiatric diseases. There is no psychotropic medication that has been approved by FDA or recommended by NICE guidelines nevertheless polypharmacy is routinely prescribed in patients with BPD

To domenstrate the possibility of using Asenapine in treating Border line personality disorder

Case :A case seen in our practice of a patient with Borderline Personality presenting with symptoms of affective instability,impulsivity,quasipsychotic symptoms that have not responded to trial of many different antipsychotics.She was started on Asenapine and experienced significant improvement in symptoms and daily functioning.However her medication was changed due to Asenapine being non formulary and this caused relapse in her mental state.She reported erratic sleep,poor appetite,anxiety and aggression.Asenapine was restarted and she improved.

Asenapine belongs to the chemical class of dibenzo-oxepino pyrroles and acts antagonistically at a number of receptors, and this combination of receptor-binding affinities differs from other available antipsychotics. Asenapine has high affinity for several 5-hydroxytryptamine (5-HT)-receptor subtypes, including 5- HT2C , 5-HT2A , 5-HT7 , 5-HT2B , and 5-HT6(Musselman et al. AP 2021; 10.1177). Asenapine’s favourable weight and metabolic profile are of clinical interest. Asenapine was generally safe and well tolerated in paediatric patients (Dogterom et al. 2018 ; Drug Des Devel Ther 12:2677-2693). One open label study that looked at efficacy of Asenapine in BPD showed improvement with Asenapine in not only affective but also improve impulsive and cognitive symptoms( Martı´n-Blancoet al. ICP 2014 ;29(2):120-3). The results of both the CGI-BPD and the BSL-23 scales, which reflect the view of clinician and patients, respectively, show a significant improvement in the BPD general symptomatology ( Martı´n-Blancoet al. ICP 2014 ;29(2):120-3). In our case patient reported worsening of symptoms after Asenapine was discontinued.She experienced suicidal ideation, impulsivity, aggression, erratic sleep wake cycle and poor appetite.On restarting Asenapine there was significant improvement in her symptoms and marked subjective improvement in activities of daily living.

Asenapine has therapeutic efficacy as well as good tolerability and safety profile.It can be used in patients with BPD especially when other antipsychotics have caused undesirable side effects like weight gain.

None Declared

Factitious hematemesis is the bleeding type of Munchausen’s syndrome together with dual diagnosis of school refusal is rarely reported in the literature. It is a condition in which the patient intentionally produces symptoms to assume a sick role and gain medical attention. Underdiagnosis of this disorder results in the unnecessary use of medical resources, i.e. unnecessary medical tests and evaluations.

case

We present this rare case of a patient with chronic factitious disorder who presented to the emergency with hematemesis. The 12 year old male patient grade 6 student presented with curious history of hematemesis just before the entrance of school and in the new school premises since 2 years resulting in school refusal and multiple doctor shopping. The patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, complete blood evaluations) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, endocopic studies etc), because he continually presented with hematemesis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when he was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient’s history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hematemesis in Munchausen’s syndrome was made.

The typical characteristics that should prompt the physician to include Munchausen syndrome in the diagnosis include deliberately lying, repeatedly coming to the clinic/hospital with similar complaints in a short span of time, taking excessive drugs (especially insulin and warfarin) to induce side-effects, recurrent abdominal pain, scars on limbs, and rheumatologic and hematological disorders.

We recommend that physicians all across the globe should report more cases of Munchausen syndrome. More research is required in this arena to understand the cultural, social, and psychological aspects of Munchausen syndrome and to find out which treatment strategy can be most beneficial for such patients

Munchausen syndrome is a diagnostic dilemma that needs to be given adequate medical and social attention by encouraging further research and spreading awareness not only amongst the general population but also health care providers. With proper evaluation, diagnosis, and psychotherapy, the disease will not remain a diagnostic dilemma and would be easier to control and treat. This case report will contribute towards the awareness of physicians about Munchausen syndrome and the strategies to diagnose and treat it.

None Declared