Depression during pregnancy can appear with a prevalence of up to 11% of pregnant women. Psychotherapeutic treatment in these cases is considered the first option, but treatment with antidepressants is sometimes required in these cases.

To present a clinical case of a pregnant patient diagnosed with depression.

Literature review of the psychopharmacological treatment of depression during pregnancy and possible complications.

A 25y Year old woman, 22 weeks pregnant, who lives with her partner. She has no background in mental health. Paternal aunt diagnosed with type I Bipolar Disorder. She goes to the Mental Health Center for evaluation, due to anxiety and depressive symptoms of 4 weeks of evolution, she refers sadness and apathy, continuous crying, somatic anxiety and obsessive ruminations in relation to childbirth and inability to care for your child. Suicidal ideation as a resolution of her discomfort. She presents with global insomnia and a significant loss of appetite, with a weight loss of 3 kg. Treatment with sertraline 50 mg/day was started, with good tolerance and clinical response

The psychopharmacological treatment of antenatal depression is a challenge for the psychiatric professional. In all cases, an adequate balance must be made between the risks and complications for the fetus and the psychopathological stability of the pregnant woman. Among the main risks of untreated depression are: preterm delivery and low birth weight, an increased risk of suicide and alterations in the development during the baby’s infancy. The most used antidepressants are the SSRIs, with sertraline being a good option. Paroxetine has been associated with cardiac defects in the newborn. There are studies with tricyclics and duals but no specific teratogenic pattern has been seen. They are associated with an increased risk of spontaneous abortion. Exposure during the third trimester may be associated with obstetric complications.

None Declared

olanzapine and carbamazepine are effectively used in treatment of schizoaffective disorder but they can have numerous side effects including skin eruptions that can be severe sometimes.

To study the relationship between toxidermia and treatment with Olanzapine and Carbamazepine.

We report the case of a patient who developed a psoriasiform skin rash following the intake of Olanzapine and Carbamazepine.

Mrs SL, 46 years old, with no prior medical or surgical history, has been diagnosed with schizophrenia since the age of 26. She was initially treated with Haloperidol and Risperidone with an irregular follow-up. Then, due to the emergence of mood disorder symptoms, the patient was put on 20 mg/day of Olanzapine and 400 mg/day of carbamazepine. One month later, the patient presented a generalized rash requiring the discontinuation of the current medications. She was treated with corticosteroids, and then she was referred to our department to make the appropriate adjustment of her psychiatric treatment.

In view of the persistence of a dry erythroderma with erosive lesions of scratching and palmoplantar keratoderma, a skin biopsy was performed showing a psoriasiform and eosinophilic dermatosis that could be consistent with a toxidermia. The pharmacovigilance investigation concluded the incrimination of Olanzapine and carbamazepine in this symptomatology and recommended to avoid their prescription for this patient.

The need for a mood stabilizer presented us with a challenge, particularly in view of the potential risk of cross-toxicity. We opted for the reintroduction of Risperidone with strict monitoring of the skin condition.

Each prescribed drug must be considered as potentially capable of causing cutaneous reactions as an adverse effect. Both the prescriber and the patient must be made aware of this phenomenon.

None Declared

We present the case of a 78-year-old man with multiple somatic pathologies and associated depressive symptoms, under treatment with Citalopram 10mg, who was admitted due to cholangitis secondary to biliary prosthetic obstruction.

Empirical antibiotic treatment with Meropenem and Linezolid was started, along with an increase in the dose of Citalopram to 20mg due to mood worsening. The patient begins with symptoms consisting of complex and polymorphic visual hallucinosis, without any affective or behavioral repercussions. He does not present another semiology of the psychotic sphere.

To highlight the importance of knowing the different interactions and adverse effects of drugs for good clinical management.

We collected the complete medical history of our patient and we carried out a review of the interactions and adverse effects described with the antibiotic drug Linezolid.

As the onset of hallucinations was temporarily correlated with the use of medications, drug-induced hallucinations were suspected, resolving completely after 2 days after withdrawal of Linezolid treatment.

Linezolid is a nonselective inhibitor of MAO A and B, preventing the destruction of monoamine neurotransmitters like serotonin, dopamine, or norepinephrine. It has dopaminergic properties that may enhance the central nervous system effects of anticholinergics and co-prescription with serotonergic drugs increases the risk of serotonin syndrome.

This case highlights the importance of taking into account drug interactions and adverse effects to reduce the risk of drug induced symptoms and optimize their management.

The increase in resistance to antibiotic treatment allows us to anticipate that the use of Linezolid will increase in the coming years, and it is important to know its mechanism of action given the interactions with psychotropic drugs that we use in our usual clinical practice

None Declared

Serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants thanks to the overall safety and tolerability spectrum. However, they can cause different side effects that not all of them are well identified.

We intend to clarify the clinical presentation of mydriasis caused by Escitalopram.

Reporting the case of a patient suffering a major depressive disorder, that presented a mydriasis after adjusting her antidepressant medication. Then, we conducted a literature review using “PubMed” database and keywords “Mydriasis”, “escitalopram”, “SSRI”,” side effects”.

A 29-year-old female with no past clinical history, presented in May 2021 a severe depression requiring an antidepressant treatment. Under 10 mg per day of escitalopram there was a partial remission of the symptoms, leading to increase the dose by another 10 mg. One month after taking 20 mg/day, she consults before the appointment suffering from a blurry vision and photophobia. Ophthalmologic examination showed a bilateral reactive half-mydriasis, eye pressure was 14 mmHg and fundus examination was normal. Iatrogenic origin of mydriasis was suspected. A gradual interruption of the medication lead to disappearance of the latter. A pharmacological investigation concluded to the suspension of escitalopram and to be vigilant if an antidepressant medication would be needed.

Mydriasis is an uncommon side effect caused by SSRI that needs to be kept in mind by clinicians. Therapeutic patient education can help to detect abnormal side effects and treat them if needed.

None Declared

According to the ICD-10 classification system, manic episodes in bipolar affective disorder (BAD) are typically characterised by sudden onset of symptoms and a duration between two weeks and five months. Mood stabilizers and 2nd generation antipsychotics are recommended as first-line treatment. Herein we report a young individual with Bipolar Affective Disorder (BAD), who had an unexpected response to medication given his pharmacogenomic results.

To investigate the clinical use of the pharmagenomic results of antipsychotic treatment.

Clinical assessment, psychometric evaluation and pharmacogenomic analysis.

Cerebral CT scanning showed dilatation of the ventricular system and subarachnoid spaces, findings that are not compatible with the patient’s age, but are seen in individuals with BAD (Keener & Phillips, 2007).

For the purposes of psychological evaluation, her underwent the psychometric assessments Rorschach and MMPI. Rorschach evaluation showed mild manic traits with grandiose ideas and dissocial personality traits through hetero-catastrophic ideas. The MMPI evaluation indicated a psychopathic personality with borderline traits. His clinical examination and psychiatric history confirmed the diagnosis of BAD.

In order to investigate the patient’s poor response to prior pharmacological treatment and determine the future optimal, we referred him for pharmacogenomic testing. The latter involved determination of allele frequencies predicting variations in activity of cytochrome (CYP) P450 drug metabolizing enzymes. Genotyping of CYP450 is known to have a clinical impact on treatment choice and dosage adjustment in patients with BAD (Yenilmez, Tamam, Karaytug & Tuli, 2018). Based on his results, he was discharged on aripiprazole.

He scored 44 in YMRS (Young Mania Rating Scale) upon admission. Blood tests were normal and no other health problems were evident.

Twenty days later, the patient was re-admitted due to clinical deterioration, which prompted the replacement of aripiprazole with olanzapine. He responded satisfactorily to olanzapine and was discharged in good condition on a dosage of 10mg OD and amp 405mg once/month. He continued his treatment with valproic acid 2000mg daily.

The patient responded well to olanzapine, which is strongly related to the CYP1A2 enzyme. Based on the prediction that he would be a rapid metabolizer, olanzapine should only have been effective at higher doses. Besides, the patient was a smoker, meaning he should have required even higher doses, as smoking induces the CYP1A2 enzyme.

None Declared

Current clinical guidelines recommend the use of clozapine for the treatment of refractory schizophrenia, present in up to a third of patients with this disease. Despite the evidence, the data point to low prescription, underdosing, and delayed initiation.

The objective of the study is to elucidate which factors may interfere in clozpine prescription.

This is a cross-sectional observational study, carried out using a survey designed specifically for it.

It was answered online by seventy psychiatrists affiliated with the Catalan Society of Psychiatry.

More than half admitted having prescribed two or more antipsychotics without having previously ruled out pseudorefractoriness through depot treatment. 70% recognized the need for monitoring as the main prescription barrier, while the main reason for withdrawal was its adverse effects. The most alarming was considered agranulocytosis, with drooling, drowsiness and weight gain being the most reported.

Statistically significant differences (p=0.031) were found in relation to the years of experience and the device where clozapine was preferred to be started: <10 years in hospital, 10-20 years in partial hospitalization and >20 years outpatient office.

Statistically significant differences were observed in the preference of the device for its initiation depending on the usual work device: hospitalization (p<0.000) and partial hospitalization (p=0.046) preferred to schedule it from their respective devices, without any preference in consultations.

The level of experience and the most reported side effect were statistically significant: for the newest psychiatrists it was weight gain (p=0.031), without presenting differences in the rest of the groups.

Clozapine is the psychoactive drug of choice in refractory schizophrenia, so efforts should be devoted to reducing prescription barriers, offering training on its management and innovating forms of monitoring to promote its use.

None Declared

Olanzapine is a second generation antipsychotic that is approved for the treatment of schizophrenia, bipolar disorder type 1 as monotherapy, or as an add-on to lithium or valproate (manic or mixed episodes), and it is also used off label for acute anxiety, insomnia… It is one of the most effective antipsychotics but concerns remain due to its significant metabolic adverse effects. Olanzapine has one of the highest rates of weight gain among all antipsychotic drugs, which challenges patient’s adherence to treatment.

Review how much influence Olanzapine has on weight gain, its influence in treatment adherence and alternatives in clinical practice.

Presentation of a patient’s case and review of existing literature, in regards to Olanzapine and its repercussions on weight gain and the old and new alternatives available right now.

Olanzapine is an effective antipsychotic, however, it causes secondary effects that complicate treatment, especially weight gain. In the case presented, the patient does gain weight with Olanzapine and adherence is compromised. In these cases, professionals try to look for alternatives, either to try another drug or use adjunct treatment. In this patient, a change to lithium was made. In the last few years, adjunct treatment has gained traction, like for example: metformin and topiramate. The latest discovery in this matter are opioid antagonists: single dose oral tablet Olanzapine/samidorphan.

Even though Olanzapine is one of the most effective antipsychotics and medications in mental health, its impact on patients’ weight hinders treatment continuity. The use of other already known medications and the appearance of new ones, that reduce weight gain probability, are the possible ways forward.

None Declared

Clozapine is the only available treatment for refractory schizophrenia and is rarely associated with the development of myocarditis. Usually, the onset of symptoms occurs within the first month of treatment. The symptoms of myocarditis include fever, flu-like symptoms, fatigue, and dyspnea, symptoms that overlap with the COVID-19 infection. Coronavirus has been associated with cardiovascular complications, including myocarditis. It is not known whether clozapine increases the risk of developing viral myocarditis in patients with COVID-19 infection.

Report a case of myocarditis in a patient treated with clozapine, who also had a history of COVID-19 infection.

Collection of clinical information and review of the literature.

A 24-year-old man was admitted following severe psychotic symptoms that have been developing for the past several months. He presented with disorganized speech and behavior, paranoid delusions, thought alienation, auditory hallucinations, and blunted affect. He had no known medical co-morbidity, but he had tested positive for COVID-19 the month before admission. The lab and imaging tests and the electrocardiogram (EKG) were normal. He was diagnosed with schizophrenia and after treatment failure with three antipsychotics, the patient was started on clozapine, with symptom improvement. Two weeks after clozapine initiation, he started flu-like symptoms, fever, chest pain, and tachycardia. Lab tests showed leukocytosis (12 400 cells/uL), elevated inflammatory markers (C-reactive protein 143,30 mg/L) and cardiac biomarkers (troponin I 12.139 ng/mL, NT-proBNP 9321 pg/ml). The evaluation for viruses, including SARS-CoV-2, was negative. The EKG revealed ST-segment elevations and a transthoracic echocardiogram showed systolic dysfunction (left ventricular ejection fraction was 37%). Cardiac magnetic resonance confirmed severe left ventricular dysfunction and diffuse myocardial edema. The patient’s symptoms resolved following the discontinuation of clozapine and supportive therapies. Troponin and EKG normalized over the following 7 days. By this time, the patient tested positive for COVID-19.

The temporal relationship with the initiation of clozapine supports the diagnosis of clozapine-associated myocarditis. However, the COVID-19 infection may have played a part in the emergence of cardiac alterations. We hypothesize that the co-occurrence of COVID-19 and clozapine treatment may act synergically as both factors increase the risk of developing myocarditis. However, further studies are needed to evaluate the relationship between these factors. While clinicians should stay alert for the risk of clozapine-associated myocarditis, the overall risk is low, and given the effectiveness of clozapine, as well as the absence of other evidence-based treatments, people with refractory schizophrenia should be given a monitored trial of clozapine, regardless of their COVID-19 status.

None Declared

Mirtazapine is an antidepressant commonly prescribed to patients with depression and problems with weight and sleep. Case reports on Mirtazapine-induced psychosis either on initiation or increase in dosage in elderly patients and those with renal and liver impairment are found in the literature.

To present a case of Mirtazapine-induced psychosis in a patient with severe malnutrition, and with no history of psychosis and despite on sedating antipsychotic.

This is a case report.

Ms. NC, a 40-year-old female with major depressive disorder, anorexia nervosa, stimulant use disorder, and sedative, anxiolytic, hypnotic use disorder with no history of psychosis even when intoxicated or during withdrawal, was admitted for involuntary inpatient psychiatric care for detoxification and management of severe malnutrition. Ms. NC has always been conscious with her weight growing up but it was only during the COVID-19 pandemic that excessive preoccupation with weight and symptoms of clinical depression were noted. Ms. NC restricted her diet and engaged in excessive exercise resulting to BMI of 16.1. She started use cocaine and diazepam daily to address the weight and mood, and sleep and anxiety, respectively. Due to a suicidal attempt, consult was done with a psychiatrist, and patient was eventually maintained on Mirtazapine 30mg and Gabapentin 100mg which addressed the mood and sleep. Despite improvement in mood and decrease in use of cocaine and diazepam, patient started to use methamphetamine around once a week. Despite with euthymic mood, preoccupation with weight resurfaced. After a few months, she restricted her food intake to only four times a week with no binge-eating or purging resulting to BMI to 13.8. Upon admission, Mirtazapine 30mg was continued and Gabapentin was increased to 300mg. Special care in her food intake was done to prevent refeeding syndrome. Benzodiazepine withdrawals symptoms were minimal. She has normal values for electrolytes, liver function tests and creatinine. On the first days of admission, she was noted to be irritable and was mostly asleep. On the fifth hospital day, she started to have difficulty sleeping and was placed on Olanzapine up to 10mg and Gabapentin 600mg but no improvement in sleep. On the tenth hospital day, Mirtazapine was increased to 45mg and later in the night, had visual and auditory hallucinations and paranoia. Upon discontinuation of Mirtazapine and initiation with Clozapine up to 75mg, the psychosis resolved after five days.

Mirtazapine-induced psychosis may be seen in patients with severe malnutrition. Despite its advantages in terms of weight gain and sleep, psychiatrists should be wary of this possible side effect when initiating or increasing Mirtazapine for patients with severe malnutrition.

None Declared

Acute dystonia is a type of extrapyramidal effect that is produced by the blockade of dopaminergic D2 receptors typical of antipsychotics. There is a subtype acute dystonia called oromandibular, which produces perioral manifestations. In extreme cases it can even produce temporomandibular joint dislocation, bilateral being more frequent than unilateral. In this abstract it is presented the clinical case of a 22-year-old female who attended to the Emergency Department due to a bilateral temporomandibular joint dislocation that was finally attributed to antipsychotic treatment.

The objective of the clinical case is to point out the importance of examination and clinical history for psychiatric diagnosis.

Review of various scientific articles related to acute dystonia.

It is a report of a 22-year-old female with no medical-surgical or psychiatric history who was imprisoned for legal conflicts. During her stay in prison, she presented reactive depressive and anxiety symptoms, receiving antidepressant and anxiolytic treatment. After two months in prison, she was released and, two days after her release, she attended to the Emergency Department due to rigid akinetic symptoms, drowsiness, mutism and urination difficulties. Complementary tests revealed bilateral temporomandibular joint dislocation, with no other organicity wich could justify the rest of the symptoms, so she was admitted to the Acute Psychiatry Unit for study.

During her admission, the physical examination (akinetic rigid picture, muscle contraction and galactorrhea) raised the possibility that it was extrapyramidal symptomatology secondary to antipsychotic treatment. Given that suspicion, intramuscular biperiden 5 mg/ml was administered, improving the condition in two hours. In a second time, the initial anamnesis was redone; the patient added that during her stay in prison she had presented psychomotor agitation for which she had recieved an intramuscular treatment that she was not able to specify. All this information confirmed the initial suspicion; it was extrapyramidal symptomatology induced by antipsychotic treatment. Thus, treatment with oral biperiden 4 mg/12 hours was continued and the condition completely remitted in five days.

In this abstract it is presented the case of a bilateral temporomandibular joint dislocation induced by antipsychotic treatment. Although it is a rare presentation, other cases like that have been described in the literature, specifically with the use of haloperidol, risperidone, amisulpride and aripiprazole. Given the high frequency of adverse effects of antipsychotics, it is essential that psychiatrists remain trained in their prediction and management.

None Declared

Phentermine is a sympathomimetic amine that the U.S Food and Drug Administration has approved for short-term use in the treatment of obesity. However, there have been case reports of phentermine being associated with neuropsychiatric symptoms, and thus caution is needed to avoid drug-drug interactions when prescribing phentermine (Nathan PJ, et al. CNS Neurosci Ther 2011;17:490-505) We present a case of phentermine-induced psychosis that could have been precipitated after being co-prescribed with fluoxetine.

To discuss a case of phentermine-induced psychosis that could have been precipitated by CYP3A4 inhibition of phentermine by fluoxetine.

Miss X is a 61-year-old female with a history of major depressive disorder, generalized anxiety disorder, obesity, and rheumatoid arthritis. Her psychiatric symptoms were stable with oral fluoxetine 60 mg daily, oral aripiprazole 2mg daily, oral amitriptyline 100mg at night, and oral lorazepam 1mg daily. Miss X was prescribed oral phentermine 15mg daily for appetite suppression for weight loss. Subsequently, she started developing paranoid delusions against her family members, generalized anxiety, increased psychomotor activity, decreased appetite, and decreased sleep. Her symptoms continued to worsen even after discontinuing her medications on the 7th day. Miss X was eventually brought to the emergency room on the 14th day as her symptoms continued to deteriorate and she could not take care of herself.

Miss X’s symptoms resolved after a dose of Intramuscular injection of 2mg of lorazepam. No signs of serotonin syndrome were present during the examination. Drug-drug interaction between phentermine and fluoxetine is suspected to be a causative factor in the precipitation of psychosis as fluoxetine can inhibit the CYP3A4 metabolism of phentermine. Her electrocardiogram also demonstrated prolonged QTc (470ms), which could have been precipitated by co-prescribing phentermine and amitriptyline. Miss X was admitted to the inpatient psychiatric unit, and oral fluoxetine 60mg daily, oral aripiprazole 2mg daily, and oral lorazepam 1mg daily were restarted. Due to QTc prolongation oral trazodone 50mg daily was started instead of amitriptyline. After her psychiatric symptoms were stable on the medication regimen, Miss X was discharged on the third day of admission to the inpatient psychiatric unit.

Our case demonstrates the caution needs to be taken when prescribing phentermine not only for its neuropsychiatric side-effects but also for drug-drug interactions.

None Declared

Functional Movement Disorders (FMD) are characterized by the presence of neurological symptoms that cannot be explained by typical neurological diseases or other medical conditions. First evidence showed that, compared to healthy controls (CTR), FMD patients presented increased levels of glutamate+glutamine in the anterior cingulate cortex/medial prefrontal cortex, and decreased levels of glutamate in the cerebrospinal fluid, suggesting that a glutamatergic dysfunction might play a role in FMD pathophysiology.

According to the evidence of these abnormalities in many neuropsychiatric disorders at level of brain network activity, connectivity, and specific anatomic areas of altered metabolic, and given the evidence of a potential role of glutamate and BDNF in the pathophysiology of FND, in this study we aimed to assess circulating levels of glutamate, BDNF, dopamine, oxidative stress biomarkers, creatinine, neopterin and uric acid in patients with FMD and in a control group of healthy subjects.

12 FMD patients (4 males, 8 females) and 20 CTR (4 males, 16 females) were recruited and underwent venous blood sampling and urine collection: levels of glutamate, BDNF, dopamine, oxidative stress, creatine, neopterin, and uric acid were analysed. Participants also underwent a psychometric assessment investigating depression, anxiety, and alexithymia.

Levels of glutamate, BDNF and dopamine were significantly lower in the blood of FMD patients than CTR. Glutamate and dopamine levels were positively associated with levels of alexithymia.

Our findings give further evidence that glutamatergic dysfunction might be involved in the pathophysiology of FMD, possibly representing a biomarker of disease; moreover, since glutamatergic and dopaminergic system are closely interconnected, our results might have a relevance in terms of treatment options for FMD patients.

None Declared

In sports psychology, the issue of finding resources to overcome stress remains relevant at present. Currently, the priority is the search for personal resources that can help overcome difficult life situations. Currently, the priority is the search for personal resources that can help overcome difficult life situations. Research by many psychologists (Folkman S., Hobfoll S., Haan N.A., Heim E., Lazarus R., Moos R.N., Schaefer C., Grin O.R., Dementiy L.I., Kalnysh V.V., Tukaiev S.V., Khazova S.A. et al) is devoted to this topic. Among the coping resources, the authors single out motivation, locus of control, resilience, self-control, purposefulness, outlook, intelligence, etc.

The purpose of the study is the analysis of literary sources regarding the study of the locus of control as a personal coping resource of an athlete.

To realize the goal of the work, the following were used: theoretical analysis and generalization of literary sources and Internet data.

According to the results of research by domestic scientists, the locus of control and responsibility can act as a coping resource. It was found that the internal locus of control is associated with a low level of anxiety, and the external one with a high one; in addition, an inverse relationship between the locus of control and the level of neuroticism was found (Dementiy, 2005). This indicates that respondents with an internal locus of control are more stable in their behavior in situations that provoke anxiety and actualize personal anxiety. Internality allows a person to maintain a sense of control over the situation and his condition. It has been proven that the relationship between the locus of control and the state of anxiety depends on volitional self-control. However, along with this, the phenomenon of “heaviness of responsibility” is known in the scientific literature, which manifests itself in a sharp increase in anxiety with an internal locus of control. This may indicate that internality “loses” its resourcefulness under certain conditions: relationships between internality and anxiety are evident only at a low level of self-control. In the case when a person has developed self-control, such a connection is broken.

The generally accepted structure of personal resources, which determine the effective behavior of an individual under conditions of stress, has not yet been formed. Locus of control can act as a coping resource in the structure of self-regulation of an individual.

None Declared

In 2016, the International Olympic Committee (IOC) preliminarily recognized cheerleading as an Olympic sport. In this regard, the participation of Ukrainian cheerleaders in the 2024 Olympics in Paris is quite likely. The athlete’s performance depends on both physical and psychological factors. Human behavior depends on interaction with other people. Empathy is based on social interactions and is defined as understanding, awareness, sensitivity, and the ability to experience the feelings, thoughts, and experiences of another person. There is little research on the impact of empathy on individual athlete and team performance and performance. Psychological training in sports involves a significant amount of work with the athlete, in particular on the part of the coach: the formation of personality and interpersonal relations, the development of sports intelligence, mental functions and psychomotor qualities, etc.

The purpose of the study was to determine the level of empathy among cheerleading coaches.

The following research methods were used to realize the goal of the work: 1) theoretical analysis and generalization of literary sources and Internet data; 2) observation, questionnaire, interview; 3) method of expert evaluations; 4) method of diagnosing the level of empathy; 5) methods of non-parametric statistics.

According to the general (total) indicator of empathy, the vast majority of cheerleading coaches (n=18) fell into the group with a reduced level of empathy, which is generally characteristic of coaches of some other team sports. According to the results of the research, the following features were revealed regarding individual trends in the structure of empathy of the subjects. In particular, the lowest number of points for coaches was found on the scales “Rational component of empathy”, “Identification abilities (ability to imitate)” and “Intuition”.

The data of the conducted research show that the vast majority of the surveyed coaches are characterized by a reduced level of empathy. The most pronounced components of empathy, according to the obtained results, were such components of the coaches’ personality as penetrating abilities (ease of establishing communicative ties), emotional sensitivity and instructions that promote or hinder empathy.

None Declared

ECT’s most common side effects are headache, memory impairment, and cardiovascular changes [1]. We report the unusual case of unilateral eyelid swelling and cheek flushing as a side effect of ECT in a depressed but otherwise healthy patient.

The patient is a 53-year-old woman with a recurrent depressive disorder for 15 years with a current major depressive episode without psychotic symptoms. With therapy resistance to mirtazapine (60 mg/d) and lithium (675 mg/d; 0.75 mmol/l), an ECT series with a total of seven sessions were performed. Treatment was performed with right unilateral electrode placement according to d’Elia (RUL).

After the first session (Thymatron IV; energy: 20%; pulse width: 0.5; EEG: 45 s), marked hemifacial erythema and supraorbital lid swelling on the right side were evident. After each of the total seven sessions with adequate seizures in the EEG between 45 to 68 s, hemifacial erythema and supraorbital eyelid swelling were evident on the right side.

Both supraorbital eyelid edema occurred immediately after seizure onset, and hemifacial erythema resolved spontaneously and entirely within 10 minutes after the termination of the respective seizure.

The right side of the face appeared normal before ECT and had no injuries or abnormalities. Trauma, allergic reactions to the anesthetic, or complications of manual ventilation were excluded. In the literature, only one case report with supraorbital eyelid edema [2] and one case report with hemifacial redness of the face [3] after ECT have been described so far. We evaluate the eyelid edema and erythema that occurred in our case as isolated benign complications, most likely due to autonomic activation of facial nerves due to electrical stimulation in RUL.

None Declared

Clozapine is considered to be the most efficacious antipsychotic drug for treatment-resistant schizophrenia (TRS). Despite this, up to 70% of patients with TRS have a poor response to adequate treatment with clozapine. In order to overcome clozapine-resistance schizophrenia (CRS), a number of adjunctive therapies, including pharmacological and non-pharmacological options, have been attempted.

The objective of this paper is to highlight the efficacy of the combined electroconvulsive therapy (ECT) and oral paliperidone as a successful treatment in clozapine nonresponders suffering from schizophrenia.

We present the case of a 22-year-old female, with four years psychiatric history, which was admitted to our clinic for psychotic behavior, psychomotor agitation, verbal negativism, auditory hallucinations. During hospitalization, the patient presented behavioral disorganization, auditory, visual and tactile hallucinations, ideo-verbal barriers, poorly systematized delusional ideation (of guilt, mysticism, contamination, possession), episodes of catatonic stupor, rigidity, waxy flexibility, bizarre postures, false recognitions. Corroborating evidence, we established the diagnosis of undifferentiated schizophrenia. We initiated treatment with clozapine up to 450 mg/day and amisulpride up to 600 mg/day.

Combined treatment strategy of clozapine and amisulpride for six weeks showed no amelioration in our patient, with additional side-effects. Also, in the last four years, she had been treated with several atypical antipsychotics, which had not achieved substantial improvement. Considering that our patient did not present an adequate clinical response and the catatonic symptoms were accentuated, we decided to progressively reduce the doses of clozapine by 50 mg/day until elimination, to initiate paliperidone 12 mg/day and to conduct ECT three times a week, performing a total of six sessions. The bilateral electrode placement and brief pulse stimuli (800 mA; 8 s, 30 Hz) were applied under analgo-sedation, with no sustained severe adverse events. After performing ECT, the patient presented a favorable clinical evolution, with a decreasing trend until the remission of psychotic symptoms.

TRS was diagnosed based on the poor response to more than two kinds of atypical antipsychotics and CRS was established after the combination of clozapine and amisulpride failed to decrease persistent positive symptoms, associated with worsening of the negative symptoms. Combined therapy with paliperidone and ECT proved to be greatly effective in improving symptoms for our patient. Switching from clozapine to a previously untried atypical might be of benefit in TRS. Also, adjunctive ECT can be efficacious in CRS. Augmentation with ECT may result in a faster response, which is particularly useful among patients with high risks of self-harm.

None Declared

With a history of several decades, electroconvulsive therapy (ECT) has been carefully investigated and data supports its use as a safe and effective treatment for patients with severe depression, prolonged or severe manic episodes and catatonia. However, ECT is still regarded with reluctance by patients and caregivers, and its acceptance and use seem to be controversial even for psychiatrists.

To investigate the access to opportunities of training in ECT among early career psychiatrists and their views regarding the place of ECT in modern psychiatry.

A cross-sectional study was conducted between July and December 2022 utilizing an anonymous online survey consisting of 36 multiple-choice and Likert scale questions.

These preliminary findings show a great discrepancy regarding the availability of ECT training in European countries, as access to specialized ECT centers is unavailable in some areas. Early career psychiatrists who had access to ECT training are more knowledgeable about the indications, precautions and side effects of this method. Most of our respondents consider ECT both an effective and a safe treatment option and have expressed their wish to improve their theoretical and practical competencies in ECT.

ECT is a standard treatment and a therapeutic mainstay in psychiatry but is being less performed in some countries. Early career psychiatrists lack experience with ECT but are interested in training opportunities. Future actions are needed for the improvement of education and training in ECT.

None Declared

Catatonia is diagnosed in 5–43% of patients with various mental disorders, thus actualizing the problem of elaborating therapeutic interventions for catatonia on an outpatient basis. Although the current experience in application of transcranial magnetic stimulation (TMS) in catatonia is limited, it provides promising data on positive effect of dorsolateral prefrontal cortex (DLPFC) stimulation in a series of clinical observations. According to the available data, TMS shows comparable efficacy with electroconvulsive therapy, but unlike it is safe and does not require general anesthesia in intensive care unit.

to evaluate the efficacy and safety of TMS in the treatment of catatonia in patients with mental disorders

Four patients were diagnosed with catatonia as part of schizophrenia spectrum disorders in three cases (P1,4,7) and in one case within the structure of recurrent depression phase (P8). Psychopathological examination includes PANSS, SAS, NSA-4, BFCRS, NCRS, and BACS.

Personalized choice of stimulation protocol was determined by rCBF lateralization in DLPFC reflecting the neuronal activity in that region: 1) P1, P4, and P8 underwent 20 sessions of high-frequency stimulation at the frequency of 20 Hz with the amplitude of 120% MT in the projection of left DLPFC 2) P7 underwent 20 sessions of low-frequency stimulation at the frequency of 1 Hz with the amplitude of 120% MT in the projection of right DLPFC

Safety evaluation was performed daily during TMS sessions. None of participants reported any adverse events at high compliance.

The efficacy was estimated during by the following criteria: 1) positive clinical response: decline of BFCRS and NCRS scores by 70% from the primary evaluation 2) achievement symptomatic remission (total BFCRS and NCRS score 3 and less).

Positive clinical response was detected in all four patients, however, symptomatic remission was formed only in two of them (P1 and P4) referring to BFCRS.

Evaluation of neurotransmitter concentration: P1, P7, P8 showed a tendency for absolute and relative glutamate concentration values to approach normal. After the TMS course GABA concentration diminished in all cases but P4, in whom the elevation of GABA level was registered.

TMS potentially activates metabolic processes in brain tissues, thus promoting deceleration of pathological mechanisms and potentiating neuroplasticity with procognitive effect, expressed primarily in the increase of processing speed and response to it, as well as in the improvement of working memory. To summarize, the influence of TMS on local brain regions makes it possible to achieve a positive clinical effect in treatment of catatonia.

No strong and unequivocal results were received for the efficacy of TMS in treatment of catatonia. A positive clinical effect was seen, however, insufficient for achieving remission in the majority of subjects.

None Declared

Depression continues to be a leading cause of disability worldwide. Despite the availability of several classes of antidepressants, a third of patients do not recover from their depression. Deep brain stimulation (DBS) is an invasive treatment approach that was found to be effective in the treatment of Parkinson’s Disease and presents as an alternative to standard antidepressant therapy for people with treatment-resistent depression (TRD).

We aimed to compare the use of DBS to standard antidepressant therapy and decipher whether DBS can be used for TRD. In addition, electroconvulsive therapy (ECT), a current brain stimulation method administered for TRD, was contrasted with DBS.

A narrative review of the current literature concerning DBS application and TRD was conducted to evaluate whether standard antidepressant therapy was as effective as psychosurgical intervention. Emphasis on TRD-associated DBS was noted.

The studies discussed found that DBS was an effective treatment option for TRD, however, the results were limited due to the studies being conducted in small sample sizes and using DBS in combination with antidepressant therapy. Nonetheless, the concomitant use of DBS and antidepressants demonstrated to be an effective treatment for TRD, highlighting the potential benefit of DBS in inducing remission in TRD. DBS has a wider range of complications compared to ECT as it involves a more invasive neurosurgical approach to implant the device. On comparing the cost of the devices between the 2 studies, DBS costs approximately three times more than ECT.

The spectrum of depressive disorders is known to affect multiple regions of the brain. A more cohesive approach would be a comprehensive study using DBS in multiple brain regions while incorporating blinded controls. In summary, DBS could be a viable treatment addition for TRD, but more thorough studies are needed to deduce its true efficacy. Future collaborative studies investigating the efficacy of DBS over ECT in TRD may assess further therapeutic potential.

None Declared

To fully comprehend and appreciate the impact of psychosurgery on treatment-resistant depression it is pertinent to review its initial development and subsequent history. By reviewing previous studies of psychosurgery, we can build a narrative of what was, what currently is and what might be. Assessing the complex philosophical dilemma of the mind and the impact this has on individuals’ concept of psychosurgery has helped to bridge the gap between Neurosurgery and Psychiatry.

We aimed to examine this question, starting at the very beginnings of our concept of mind, working through to modern-day thinking, how we approach both neurosurgery and psychiatry and help to bridge the two.

A narrative review of the current literature concerning neurosurgery for mental disorders and said applications to modern psychiatry was conducted. Emphasis on philosophical thought processing in conjunction with the neurosurgical intervention was noted.

Psychosurgery has its roots in the early philosophy of mind, concerned with distinguishing whether the mind is a physical entity or immaterial. Psychosurgery is reliant on a physical concept of the mind, or at the very least that the mind supervenes the physical brain. History has shown us examples of this, with the archetype of this being the story of Phineas Gage. Since its onset psychosurgery has moved in and out of vogue. After being met with early scepticism it later went on to be performed thousands of times to help cure schizophrenia. In the 1800s, Gottlieb Burkhardt pioneered initial surgical interventions on the brain with intended psychiatric outcomes, moving on to work from Egas Moniz and the development of leucotomies and famously lobotomies, to modern medical techniques of Deep Brain Stimulation.

Psychosurgery has faced much opposition throughout history due to the uniquely invasive nature of not just affecting us physically but also mentally and the implications that this has for us as humans and our understanding of ourselves. As both medical and cultural views of mental health have changed over time, so has our understanding of psychosurgery and its potential applications. It is possible that early attempts to implement psychosurgery, before the advent of modern medicine, did more harm to psychosurgery’s reputation than good. However, without those early forays, we may never have progressed to the modern techniques we now utilise.

None Declared