For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.

Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.

Clinical case report and review of the literature on the subject.

We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.

This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.

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After severe brain trauma, patients undergo long periods of intrahospital treatment, rehabilitation and multidisciplinary evaluations. When they are sufficiently autonomous, they can be admitted to institution for health care, psychotherapy, occupational therapy as well as various efforts to improve their autonomy. The place taken by family can vary according to the project of the institution and their disponibility.

The family group therapy with an organized and structured program aim to improve the place that family have in this institution.

Family group therapy can vary from support group to structured cognitive behavioural therapy and psycho-education. To meet our goal, we used the model from an experienced brain trauma center.

As a result, better communication between family and resident, family and staff, improved acceptance and a relief for families were found.

In spite of lesser disponibility, the families already stress their need and gratitude for family group therapy.

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Autism Spectrum Disorders (ASD) refersto a condition where behavioral and social communication aspects are altered, at different levels of impairment. Relating the characteristics of ASD to the united of brain functioning, alterations in the state of alertness or brain wlkefulness are observed; in the reception, analysis and storage of information and elaboration, programming and execution os activities. The speech therapist is the professional capable of evaluating, diagnosing, preventing and intervening in cases of language impairment, however, there are still few instruments for acessible cognitive investigatio that can guide the professional in the elaboration of a more effective therapeutic plan. Such a lack leads to the need for a longer period of evaluation ans intervention. The present study aims to develop a Cognitive Protocol for Speech language Pathology investigation aimed at children with ASD.

Elaboration of the Speech-Language Pathology Protocol for cognitive Investigation aimed at children with ASD (PROFOCO-ASD). In this process, a pre-test was developed to identify difficulties observed by parents and guardians in in understanding, vocabulary, perception of changes and in the response time, in search of better affectiveness of the instrument.

PROFOCO-ASD has been developed as a doctoral thesis by São Paulo University (USP) and is based on literature review, authors experience, pre-test in target audience and panel of experts. It is a cognitive investigation protocol aimed at children aged between 2 and 12 years with a diagnosis of asd. In the pre-tes phase, 10 parents answers the PROFOCO-ASD , in addition to a separate questionnaire containing questions regarding: a. Understanding of the questions. b. Understanding of the vocabulary userd. c. Perception of the child’s changes, according to the questions asked. d. response time.

the results demonstrated the need for changes in the preparation of the questionnaires, in the vocabulary used, in the size of the questionnaire and in the need for guidance on cognitive alterations, so that párents and guardians could identify them.

The Cognitive Speech-language Pathologist pROTOCOL (PROFOCO-ASD) is a intrument aimed at the speech´language patholist capable of proving a means of identifying fundamental cognitive alterations of language development. In search of greater effectiveness, a pre test was applied in wich parents and guardians answered the questions. The results of the pre-test led to a modification of the protocol, wich had now passed though the expert panel stage.

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Stigma in mental health settings is described as a set of negative and unrealistic beliefs about those with mental illness. Authors suggest that stigma is consistently underdefined and overused, leading to resources toward preventing and managing this problem lacking intention and efficiency. Three interacting levels of stigma are defined: social, structural, and internalized or self-stigma. Internalized stigma refers to how people with mental illness see themselves as mentally unwell and, therefore, of lesser value.

We aim to discuss the impact of internalized stigma on psychiatric patients and ways of prevention and stigma resistance.

We performed a non-systematic literature review from the data base PubMed using the key words “internalized stigma” and “mental illness”.

Internalized stigma is one of the major factors leading to delayed contact with psychiatric care up to two years in outpatients. In psychiatric patients, higher internalized stigma was associated with weakened social support and integration, hopelessness and lower self-esteem and sense of coherence. Low self-esteem is the most significantly associated factor and mediates lower quality of life and higher treatment avoidance. The risk of self-esteem loss seems higher in patients with more insight, especially if they also have a loss of valued social identity. Although some studies suggest higher levels of internalized stigma in female, single and lower educated patients, adjusted statistical analyses do not validate these sociodemographic variations. It is however more prevalent in those with depression and who had been hospitalized because of their mental illness. The impact of internalized stigma is often compared to the levels of the illness burden itself, leading to higher levels of depression and greater psychiatric symptom severity. Additionally, more self-stigma seems to predict suicidal ideation, particularly in young adults.

The internalization of negative stereotypes undermines empowerment and negatively impacts the evolution and recovery of psychiatric patients. There’s strong evidence that general stigma constitutes a risk factor for poor biopsychosocial health outcomes. Programs addressing multiple stigma components seem to be most effective in improving suicide prevention. However, most self-stigma interventions involve groups, which can create barriers for people who are not comfortable disclosing a mental health condition to others. Anti-stigma programs are most effective when they involve people with lived experience of mental health conditions in all aspects of development. Interventions from a younger age should focus on prevention of general stigma by improving understanding of mental illness and reducing self and outwards discrimination. Working on professionals own stigmatizing behaviors is also key to improve the way we communicate and educate populations on how to internally process mental health problems.

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Limited data is available on the prognosis of patients with FND concerning their ability to return to work.

To identify factors associated with the ability to return to work in patients with FND following treatment and rehabilitation.

We retrospectively assessed the employment outcomes of 79 consecutively evaluated patients. Patients were referred at the inception of an FND Program for adults. The majority of patients were unemployed, on sickness leave and or disability benefits at the time of their referral (n=71). Their median age was 48 years. Most patients were of female gender (n=50), in a relationship (n=53), with no dependants (n=64). Most patients had a referral diagnosis of mixed functional neurological symptoms (n=35), presenting with a combination of motor, sensory, cogniform or dissociative seizure symptoms. Among patients distinct phenomenological presentations, the most common referral diagnosis was functional sensory disorder (n=16). Twenty two patients had a concurrent structural neurological disorder. Seven patients had an accident compensation claim, and twenty had a workers’ compensation or employment insurance claim at the time of referral.

Approximately 30 % of patients were able to return to some work (n=24) within five years or less, and all those who were in employment at the time of the referral continued to hold a job for the duration of their treatment. We identified a negative correlation between patients’ ability to return to work and the length of employment interruption, with patients more recently out of work (within a year prior to the referral) being most able to return to work (odds ratio = 2; 95% CI, 1.2 to 3.8). We previously analyzed employment figures at 18 months of the service operation. Return to work was moderately lower at that point at 19%, but with maintained negative correlation with the length of employment interruption.

There was a negative correlation between having a work-related financial claim and the ability to return to work (p <0.001). There was no statistically significant correlation between demographic variables (gender, age, relationship status, or having dependants) and the ability to return to work, nor was there a statistically significant correlation between the phenomenology of Functional Neurological Disorder (motor, sensory, cogniform, non-epileptic attack disorder or mixed) and the ability to return to work.

Early and continuous treatment of employed or recently unemployed patients with Functional Neurological Disorder is associated with better occupational outcomes. Having a work-related compensation claim is correlated with negative occupational outcomes. There is a need for further research into occupational rehabilitation, specially for patients receiving work-related compensation claim.

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During the war, the rehabilitation of combatants after injuries of varying degrees of complexity has particular importance. The effectiveness of rehabilitation of athletes-war veterans can be assessed by the level of physical performance, functional properties and state of all body systems. The reduction of functional asymmetry, accuracy of the sensorimotor response and dynamic muscular endurance (DME) of hand movement by the tapping test are effective and objective indicators of physical rehabilitation.

The aim of this study was to evaluate functional asymmetry, accuracy of sensorimotor response and dynamic muscular endurance of hand movement by tapping test during the rehabilitation of amateur field-and-track athletes after battle traumas.

10 war veterans (amateur field-and-track athletes, right-handed male aged between 28 and 60 years) took part in the study. To determine the state of psychophysiological functions and the maximum tempo of movement of the hand Diagnostic complex “Diagnost-1” (Ukraine) was used. We analyzed indicators of the tapping test, indicators of a simple visual-motor reaction (SVMR) and a reaction of choosing one of three signals (RCh1-3) separately for the right and left hand, indicators of a reaction of choosing two of three signals (RCh2-3). Non-parametric statistics methods (Spearman’s rank correlation coefficient) were used to process data.

The accuracy of the sensorimotor reaction (according to the SVMR indicators) corresponded to the average level in the majority of athletes (60%). The indicators of the simple response of the choice of RCh1-3 were below the average (20%) or at a reduced level (50% of the examined). DME of the dominant hand was high or medium in 40% and 60% participants respectively. In 90% of the surveyed athletes, asymmetry in terms of the tapping test is moderately expressed. Results showed the significant correlation between the stability index of the simple visuomotor reaction (SVMR) and the dynamic muscular endurance (DME) indicators for the dominant and subdominant hand (r = 0.75, r = 0.71, p<0.05, respectively) - the greater DME corresponded to the lower stability of the SVMR. Latency periods of simple visuomotor reaction and their components (motor components of SVMR, RCh1-3, RCh2-3 reactions and the time of central processing of information in choice reactions) were not associated with tapping test indicators.

Therefore, it can be assumed that motor components of a simple visuomotor reaction, choice reactions and the time of central processing of information in choice reactions were not related to dynamic muscle endurance. The revealed interrelations between the stability of the sensorimotor response and the dynamic muscular endurance of the hand movement can be indicators of the successful rehabilitation of amateur athletes after injury.

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Currently, there is an active introduction of modern types of psychosocial treatment (PST). At the same time, an important direction is the evaluation of the effectiveness of PST, the identification of factors affecting it, which determines the urgency of research in this area.

To evaluate the effectiveness of psychosocial treatment of patients with schizophrenia at different stages of psychiatric care; to build regression models to identify factors that influence the effectiveness of psychosocial treatment.

Clinical and psychopathological, statistical, as well as a battery of tests: PANSS, CGI; Drug Attitude Inventory (DAI, Hogan T.P. et al., 1983); Insight Scale for Psychosis (ISP, Birchwood M., 1994); «SF-36 Health Status Survey» (SF-36, Ware J.E. et al., 1993); URICA (McConnaughy E.A. et al., 1983); The Social Adjustment Scale-Self (SAS-SR, Weissman M, Bothwell S.,1976); PSP (Morosini P.L. et al., 2000) and a number of other scales. 90 patients with schizophrenia in the community, inpatient department of psychiatric hospital, day hospital participated in the basic PST program, which included psychoeducation, motivational training, social and cognitive skills training. At each stage, PST was received by 30 patients who did not differ significantly in age and other socio-demographic characteristics, but were characterized by different quality of remission, the duration of the PST program was 3 months. The assessment of the patients’ condition was carried out before and after the rehabilitation program.

A significant improvement in the indicators on the PANSS scale was found in patients of all three groups, as evidenced by a reduction of more than 10 points in the total score of the scale. As a result of the PST program, patients of all three groups have improved to varying degrees their awareness of the disease understanding of the need for drug treatment, increased motivation, and have shown a tendency to improve a number of cognitive functions. The participants of the program demonstrated an increase in the level of activity and purposefulness of activity, as well as the ability to master new social skills and implement them. Correlation and regression analysis, during which more than 100 factors were studied, allowed us to identify the most significant factors that positively or negatively affected the effectiveness of PST: severity of the condition, duration of illness, age of onset of the disease, age of referral to the service, number of hospitalizations, type of remission, observation group, level of education, marital status, family support, family relationships, having friends, having income.

The effectiveness of the basic PST program has been shown. However, the work on evaluating the effectiveness of the PST should be continued, especially for the development of information criteria and a tool for its evaluation.

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The National School for Training in Mental Health Rehabilitation and Recovery at the Ono academic college operates under the auspices of, and is funded by, the Division for Mental Health Rehabilitation of the Israeli Ministry of Health. Intended to hone the quality of services provided, it offers numerous training courses, that target various populations associated with and working in the field of mental health recovery, among them clients and their family members, as well rehabilitation professionals and support personnel. The novel course of trauma and posttraumatic growth (PTG) was developed and aimed at supporting recovery, coping strategies and ultimately PTG through the lenses of both recovery and trauma informed care for psychiatric and support personnel, professionals with lived experience, and family members. It is built of eleven six hours long sessions with lectures, in-vivo assignments, and group supervision.

Portray the development, implementation, and outcomes of the course from psycho-educational, clinical, social, and personal perspectives of students as well as the course’s developers.

A case study of the course that will be portrayed through qualitative anonymous testimonials from students’ surveys and assignments, as well as the analyses of processes that the course underwent through the years.

The course has several dimensions that allow the integration between trauma, recovery, and PTG in psychiatric rehabilitation: the integration between academia and research-based knowledge with experiential knowledge; integration between the perspectives of PTG and recovery; and, integration between social and cultural perspectives and person-centred care. In addition, the course promotes trauma-informed models in psychiatric rehabilitation; offers new perspective and implantation to psychiatric recovery-oriented tools so as to promote PTG; and enhances social support and cohesion within mental health services and personnel.

The current case study portrays the unique processes of knowledge development, implementation, and training in psychiatric rehabilitation personnel, supported staff and people with lived experience. The course brings a focus on PTG as a promising addition to the trauma-informed approach in psychiatric rehabilitation, which is only scarcely linked to recovery.

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ASD is a heterogeneous group of pathological conditions.

Sensory Functions in Children with Autism

A brief review of scientific publications is presented, formed by the search result for the keywords: autism spectrum disorders, artificial intelligence, machine learning.

Patients with ASD respond to sensory information hyper-reactively and hypo-reactively. Patients, regardless of age and severity of ASD, have atypical information processing patterns in all sensory modalities. Atypical processing of stimuli correlates with social, cognitive and communication disorders.

To normalize sensory deviations, it is necessary to build corrective and prognostic models of the child’s connection with the environment. Machine learning models, Data Mining methods to make medical management decisions and develop personalized therapeutic strategies.

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Decreased sound tolerance amongst individuals can be divided into two conditions: Hyperacusis and Misophonia. Hyperacusis is the perception of certain everyday sounds as too loud or painful. Misophonia is characterized by heightened emotional reaction to a sound with a specific pattern and/or meaning to an individual, with the context in which occurs being relevant. Scattered evidence from clinical research suggests that Hyperacusis and Misophonia can co-occur with a wide range of psychiatric disorders. These factors can have an impact on the severity of the symptoms and subsequently, in the clinical management of these patients. A better understanding these comorbid conditions is important as it could help to clarify its underlying mechanisms and ultimately, to improve the care of these patients. Despite this, no attempt has been made to synthesize the spectrum of such co-occurring disorders.

To conduct a systematic review of the available evidence on the prevalence of psychiatric disorders in patients with Hyperacusis and Misophonia, and to explore which factors may influence prevalence estimates.

Preferred Reporting Items for systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) recommendations will be followed. The CoCoPop (Condition, Context and Population) framework was used to develop the review question. Pubmed, PsycINFO, Scopus and Web of Science electronic databases will be searched, as well as grey literature, using key-terms in accordance with the pre-established research question. Additional manual searches will also be conducted. Searches will be limited to human studies and no date, language or country origin restrictions will be applied. Outcomes of interest will be the occurrence of comorbid psychiatric disorders in patients with Hyperacusis and Misophonia that are reported according to validated assessment methods. Retrieved records will be screened for eligibility by two independent reviewers using a two-phase approach (title and abstracts screening and full-text review). The methodological quality of primary studies will be assessed using the Joanna Briggs Institute (JBI) – Critical Appraisal Tools, depending on study design, and data will be extracted independently using a standardized extraction form.

Quantitative data will be synthetized and presented in text and tabular format. Studies heterogeneity will be verified and if feasible, a meta-analysis will be conducted.

It is expected that this systematic review will provide evidence of a significant prevalence of a wide range of psychiatric comorbidities in patients with Hyperacusis and Misophonia, supporting the importance of screening these patients for psychiatric disorders.

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HuPoTest is a mental test and training procedure as well discovered incidentally in 1967 during developing color photos in complete dark in successive baths for seconds. I observed that I was able to count seconds mentally with high repeatability. I was curious to check my skill by comparing my count with a commercial stopwatch with the help of another person. The results were very interesting, so I extending progressively this experiment to other persons and I was able to establish the correlation between more and more calculated parameters with the particular psychic patterns of the persons under test (PUT). In fact, HuPoTest is a calibration of personal mental-timer compared to a standard stopwatch. I test myself periodically and the results are published (Dragan, GDF Databanks Bull., 2021; 25(6), 1-4).

Study of a large variety and number of systems in transformation revealed their composite structure, namely these have one component in transformation (Ctr) and an inert one (Cin) (Dragan, GDF Databanks Bull., 2011; 15(2), 1-19).This is the case of the human mind which is in permanent transformation, i.e. in continuous more or less coherent thinking. HuPoTest can establish the size of Ctr, Cin, ctr – the size of kinetic unit constituting Ctr and the coupling strength (CS) between Ctr and Cin.

PUT has to count mentally 5, 10, 15 and 20 seconds for 8-10 times each value by using a standard stopwatch and comparing the statistically retrieved matrix of measured values with the above mentioned imposed standard values. I was able to test face-to-face approximately 4000 persons during more than 50 years by collecting a huge databank. I explained in many publications the exact procedure, the majority of calculations and the significance of the resulted parameters by correlating the obtained results with the PUT mental pattern (Dragan, GDF Databanks Bull., 2019; 23(1) 1-6).

The final results obtained by myself in the period of 28.05 – 03.07.2022 (A to CII) with overall of 48 tests are presented in attached figures by using a standard stopwatch created by Mihai Dornea developer at National Instruments on LabView® platform with an accuracy of 10 μs. Four distinct behaviors are revealed showing the good evolution of mind by decreasing Ctr and CS and increasing ctr by correct and continuous training.

Image:

HuPoTest is a highly efficient test and mental training procedure as well applied periodically in view to achieve a good and stable mental performance ensuring also a stable and good body health according to the well known quotations “sound mind in sound body” and "mind is the builder and body is the temple”. Such mental training becomes absolutely necessary taking into account that the survivors of the already started global war culminating at around 2035 will be persons with properly trained minds. I am available without any obligation for help anyone willing to try and practice HuPoTest.

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European researchers are collaborating in the EU Horizon 2020-funded project “RESPOND” to address the psychological and psychosocial effects of the Covid 19 pandemic in order to prepare health systems for future crises. In the Co-RESPOND subproject, several longitudinal cohorts are contributing to an individual participant data (IPD) meta-analysis.

Co-RESPOND aims to assess trajectories of mental health and resilience, and to identify relevant moderators using a meta-analysis of individual participant data (“IPD”) approach. Moreover, a research network of European cohorts is being established alongside a sustainable shared IT infrastructure. Co-RESPOND aims to publish the results of the collaboration in a findable, accessible, interoperable and reusable way according to the “FAIR publication” principles.

To achieve these aims, a federated network for remote data analysis is being built. In this talk we describe the steps necessary to join existing cohorts into one network, and which challenges need to be met: First, existing data sets need to be harmonized retrospectively, second, data sharing and processing needs to be done in accordance with the GDPR requirements, and third, a technical solution needs to be found to facilitate joint analyses and publication of the network and its products.

We identified the Maelstroem guidelines for retrospective data harmonisation of epidemiologic studies as appropriate guidance to carry out and document the transformation of individual data sets. The OBiBa software suite is used to build the IT infrastructure of the project by connecting local data servers of the study sites and making them available for remote analyses by other partners. As of autumn 2022, data transformation is finalized and data sets uploaded on the local servers. A platform on the internet is created where the main characteristics of all participating cohorts (“meta-data”) are catalogued to help them gain visibility and make them findable for future joint projects. The Co-RESPOND network will be open for more partner cohorts to join.

The Covid pandemic has stimulated lots of international remote collaborations, and federated networks for data analyses are increasingly used as a means of enhancing the value of existing data sets. User-friendly and cost-free software solutions are already available (e.g., OBiBa) to facilitate such endeavours. However, researchers intiating cohort studies should be aware of such technology and methods and consider the use of their data in overarching collaborations from the start. We conclude with concrete recommendations how to optimize the design of epidemiologic data collections to enhance their interoperability with other cohorts, e.g., by using international coding standards.

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Psychiatric comorbidities are highly frequent in patients with epilepsy and are associated with negative outcomes. These comorbid conditions can lower the seizure threshold, increase the risk of treatment-resistant epilepsy, and reduce function and quality of life. Additionally, patients with epilepsy have an increased risk of premature mortality, including due to suicide. In this context, although hospitalizations are common in patients with epilepsy, little information on healthcare utilization associated with comorbid psychopathology is available.

To characterize psychiatric comorbidities among all hospitalizations with a primary diagnosis of epilepsy and to analyze their association with key-hospitalization outcomes, including length of stay, in-hospital mortality, estimated hospital charges, and readmissions.

An observational retrospective study will be performed using an administrative database that comprises de-identified routinely collected hospitalization data from all Portuguese mainland public hospitals. All episodes of inpatients, discharged between 2008-2015, with a primary diagnosis of epilepsy (ICD-9-CM code 345.X) will be selected. Psychiatric comorbidities as secondary diagnoses will be identified, grouped into broader categories as defined by the Clinical Classifications Software for ICD-9-CM, and computed into binary variables. Descriptive, univariate, and multivariate analyses will be used.

Descriptive and analytical statistics will be conducted to describe and characterize this sample of hospitalizations. Sociodemographic variables such as age at admission, sex, and place of residence will be characterized. Multivariate models will be used to quantify the association between psychiatric comorbidities and hospitalization outcomes, and results will be presented as crude and adjusted odds ratios.

With this nationwide analysis, we expect to better understand the additional burden of psychiatric comorbidities on epilepsy-related hospitalizations, including psychiatric diagnoses that have not been extensively investigated.

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In the last ten to fifteen years, it has become common for researchers to collect both quantitative (Sue & Ritter, 2012) and qualitative data (Jowett, Peel, & Shaw, 2011) online. The Covid-19 pandemic has increased the importance of this process and accelerated it in many disciplines (Torrentira, 2022).

In addition to convenience, recent work suggests that online data collection may be more valid than face-to-face data collection for some populations. This would mean that online data collection may be the most valid and effective for this age group (Barratt, 2012).

Adolescents with an eating disorder tend to be more open about their symptoms via impersonal online data collection than they are in a face-to-face conversation. Symptom underrating has been documented in face-to-face interviews, because “of feelings of shame elicited by the loss of anonymity during face to-face interviews” leading to face-to-face denial, whereas a self-report questionnaire allows for more privacy and hence honesty while answering questions (Berg et al. 2011). This is especially key in the diagnosis of Anorexia Nervosa (AN), as AN patients minimize, deny, and/or fail to recognize their symptoms (Passi, Bryson and Lock 2003).

Given the benefits of collecting data online for both researchers and participants, it is important to determine the quality of the data collected online to guide its use and interpretation. More evidence is needed to confirm the equivalence of online and face-to-face interview data. The current study examines the equivalence of semi-structured interview data collected online versus original face-to-face interviews.

The Eating Disorder Examination (EDE), assessing psychopathology of eating disorders, was administered to 49 adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa. The same diagnostic interview was administered twice, once via face-to-face and once as an online version, within a week. Method order was counterbalanced among participants and temporal stability was controlled. The Eating Disorder Inventory-2 (EDI-2) was used as a control variable.

Both the equivalence test and the null hypothesis test were significant for the sum score of the EDE. Measures of psychopathology in eating disorders demonstrated equivalence across face-to-face and online format of the EDE.

The aim was to examine the equivalence of face-to-face and online methodologies, controlling for temporal change in the variable under investigation over one week and order of administration. Results demonstrate equivalence across face-to-face and online format of the EDE. These findings suggest that data obtained using EDE online can be interpreted in comparison with normative data obtained in the face-to-face Interview and that corrections trough transformations are not necessary.

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The prospect of a medium-term approval of physician-assisted death in Portugal raises relevant ethical and deontological issues that need to be addressed, namely the framework of psychiatric assessments in this process. Such assessments are undermined by the lack of scientific precision in the methods used to determine decision-making capacity, making it possible for the final decision to be affected by psychiatrists’ personal beliefs. As such, outlining scientific evidence and legislation pieces defining the psychiatrists’ role and scope is of utmost importance to frame this debate.

To synthetize the accumulated evidence worldwide regarding the psychiatrists’ involvement in the global process of physician-assisted death requests by reviewing scientific literature, published protocols, official reports and international promulgated or amended legislation related to hasten death practices.

PubMed, Scopus, Web of Science, PsycInfo and Google Scholar electronic bibliographic databases will be searched for eligible articles, as well as grey literature, using the following search terms: Psychiatry AND (Euthanasia OR (Suicide AND Assisted)). Official governments’ and countries health authorities’ websites will also be searched for relevant reports and legislation documents, as well as right-to-die organizations and akin associations. No language, date of publication, or geographical restrictions will be applied. The full text of potentially relevant results will be retrieved from the different sources for review after screening titles and abstracts. This two-stage process will be conducted independently by two researchers. Outcomes of interest will be the descriptions of psychiatric role in the process of physician-assisted death requests, assessment methods, and measurement techniques used.

Given the fact that physician-assisted death is legalized only in a few jurisdictions, we believe the number of eligible results will be limited. Data will be extracted and a descriptive summary of the evidence will be provided. We anticipate finding a significant variability, but also to identify points of consensus. The findings will be published in a peer-review indexed journal and presented at national and international conferences.

To our knowledge, this is the first review of both, scientific published literature, and international legislation on the role of psychiatrists in physician-assisted death requests. We hope to provide an international overview to frame the public debate by pinpointing the most consensual assessment methodology, allowing to design an optimized assessment protocol before the implementation of the law in Portugal.

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Folie a deux, also known as shared psychotic disorder or induced delusional disorder, is a rare mental disorder that was first described in France in the late 19th century and was referred to delusions shared between two individuals in close relationship. The concept has evolved and according to ICD-10 the following criteria for the diagnosis is phenomenology-based only.

To describe a clinical case and review the existing evidence on folie a deux.

Clinical case and non-systematic review of the literature, from the last 15 years, on folie a deux. For this research, the keywords “folie a deux”, “shared psychotic disorder” and “induced delusional disorder” were used in the MEDLINE/PubMed database.

The clinical case presented refers to a 56-year-old female patient with no known psychiatric history. The patient stated that 5 years ago when his mother died, neighbors began to persecute her and her sister. She was medicated with a second-generation antipsychotic without total remission of symptoms. Generally, in folie a deux there is a close and prolonged relationship between the inducer and the receptor, as described in this case. We considered that the sister is the active subject. The delusion is persecutory, the most common in this disorder. The patient kept her job until she was hospitalized and as described in the literature patients with folie a deux maintain their functionality, which is responsible for the underdiagnosis of this disorder. The fact that the current evidence is based on case reports reflects the underdiagnosis and rarity of this disorder.

This clinical case highlights the challenging diagnosis and difficulty in treating this condition. Patients can be diagnosed many years after the onset of symptoms, which may not resolve with treatment. Much information, as prevalence, natural history, and optimal treatment, is lacking on folie a deux, and the etiology remains unknown. As such, prospective studies should be carried out to help understand this disorder.

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Psychotic symptoms have long been known to show up earlier in life, typically during adolescence and early adulthood. Late Onset Psychosis (LOP), in which symptoms start between 40 and 60 years of age, and Very Late Onset Psychosis (VLOP), in which onset of symptoms happens after 60 years of age, although classically rare, have had a growing prevalence in the last decades.

To access the definition and main etiologies of LOP and VLOP, based on the current literature.

Non-systematic review of literature using the terms “late onset psychosis” and “very late onset psychosis”. Case report of a patient who was admitted and treated in our inward patient field.

51-year-old female patient. She is divorced (two previous marriages) and has two daughters (26 and 16, respectively). She was brought by police officers because of behavior problems at the shelter where she was living. She was evicted from the house she was living in because of delay in paying the rent. On observation, she verbalizes persecutory and prejudicial delusions and auditory hallucinations on the 2nd and 3rd person (commenting voices) with at least 5 years of duration. She was hospitalized for almost 3 months, with slow but progressive clinical improvement on haloperidol 7,5mg/day. At the date of discharge, she did not spontaneously verbalize her symptoms, although she did not recognize them as delusional. Recent studies have shown that the prevalence of Schizophrenia in the typical age range is 75-80%, which means that an important proportion of diagnosis is made after that age span. Primary causes of LOP and VLOP are schizophrenia (of late onset), schizophrenia-like very late onset psychosis, delusion disorder, unipolar depression with psychotic symptoms and bipolar disorder. Secondary causes should also be considered, such as delirium, dementia (Alzheimer’s, Lewi bodies and vascular), and substances abuse; even more rare, other conditions should be considered, as cerebrovascular accident, encephalitis, epilepsy, and multiple sclerosis.

LOP and VLOP have been a growing diagnosis in the past decades. In the assessment of these patients, we must consider the importance of secondary etiologies besides the primary psychiatric ones. Primary psychosis is a diagnosis of exclusion, and the clinician must rule out secondary causes. Recent data point out these symptoms as markers for an increased risk of dementia in these patients. Further research involving individuals with LOP and VLOPs is required to increase the evidence base for treatment and improve outcomes of care.

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Epidemiological studies shows that exposure to early stress in the form of abuse and neglect in childhood increases the risk for later development of severe mental illneses such as schizophrenia and bipolar affective disorder.

•Study the prevalence of childhood trauma in a sample of adult patients diagnosed with schizophrenia and bipolar disorder.

•Identify potential differences of types of childhood trauma between both groups.

This cross-sectional study was conducted on 200 patients admitted to the inpatient unit at Maamoura psychiatric hospital in Alexandria. Assessment of the history and nature of childhood trauma was done by Arabic version of childhood trauma questionnaire (CTQ).

There was no statistically significant difference between the two studied groups regarding past history of childhood trauma (p=0.397). (Table 1) Regarding the nature of childhood trauma, the history of emotional abuse and physical neglect was more commonly associated with developing bipolar disorder whereas the history of physical abuse was sihnficantly more commonamong schizophrenia patients. (Table 2)

History of childhood trauma is common among adult patients with schizophrenia and bipolar disorder with no significant difference between both groups. Nature of trauma may be diffirent where physical abuse might be correlated with later development of schizophrenia.

None Declared

Clinical evidence supports the interaction between genetic predisposition and environmental stressors on the emergence of positive psychotic symptoms. Childhood trauma might be a modifiable risk factor among adults with serious mental illness.

The aim of our study was to investigate associations between childhood trauma (physical abuse, sexual abuse, emotional abuse, emotional neglect, and physical neglect) and symptoms of schizophrenia.

We included in our study 33 stabilized inpatients with schizophrenia at the Psychiatry C department at University Hospital in Sfax-Tunisia.

Data on Sociodemographic and clinical variables were collected from medical records.

Psychotic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). We used the Childhood Trauma Questionnaire-Short Form (CTQ-SF) to evaluate childhood trauma experiences.

Our sample was exclusively composed of men with an average age of 35 years and 4 months.

The majority of patients were unemployed (75.8%). Only 6.1% of them were married.

Among the patients included in the study, 15.2% of our patients were illiterate. The majority of subjects were treated after a period of untreated psychosis (65.5%).

The analysis revealed that 42.4% of our patients experienced childhood adversities with mean CTQ-SF total score 35.48 (SD=9.44)

We found that positive and general psychopathology schizophrenia symptomatology were correlated to Childhood abuse (0.03; 0.004), emotional abuse (0.009; 0.004), physical neglect (0.02; 0.01), and emotional neglect (0.01).

In addition, our analysis showed that only emotional abuse lead to more negative schizophrenia symptomatology (p=0.009).*

Several studies have shown an association between childhood trauma and specific symptoms of psychosis. Therefore, Childhood trauma should be considered and inquired about in the course of clinical care of schizophrenia patients.

None Declared

Schizophrenia is a neurodevelopmental process affecting approximately 1% of the population. Multiple studies have found that Childhood trauma is an important risk factor in the emergence and clinical course of schizophrenia.

The purpose of this study was to assess the characteristics of schizophrenic inpatients with childhood trauma among a tunisian sample.

Stabilized inpatients with schizophrenia at the Psychiatry C department at University Hospital in Sfax were involved in our study. Sociodemographic and clinical data of patients were collected from medical records.

We used Childhood Trauma Questionnaire-Short Form (CTQ-SF) to evaluate the occurrence of childhood maltreatment.

We recruited 33 patients, all men with a mean age of 35 years and 4 months (SD=9.44 years).

They were married in 6.1% and 24.2% of patients had regular work.

The mean age of onset of the disorder was 24.42(3.25).The level of poor psychotropic medication adherence was 72.7%.

According to CTQ-SF, 78.8% of patients had experienced child trauma with a mean score of 35.67 (SD =8.61).

A rate of 39.4% reported having experienced one child trauma, while 60.6% reported having experienced more than one.

We found high rates of emotional neglect (87.8%) while emotional and physical abuse during childhood were experienced by 39.4%, and 6% respectively and physical neglect were found in 30.3% of cases.

Patients with more than one childhood trauma were found to have an earlier onset of psychosis (p=0.004)

The occurrence of childhood trauma was not associated with the socio-demographic characteristics of the respondents or the clinical features of the disease.

The results point toward childhood emotional neglect being of specific importance to schizophrenia, which may be an area for future prevention and clinical attention.

None Declared