Family members play an important role in the life of many adults with mental disorders and are under considerable amounts of stress that may affect caregiver’s physical health, quality of life and resilience.

The present study aimed to explore the relationship between the perceived stress and the resilience levels among caregivers of patients with mental illness and to identify their associated factors.

This was a cross-sectional, descriptive and analytical study conducted on caregivers of patients suffering from mental illness. It was conducted in the outpatient psychiatry department at the university hospital of Sfax (Tunisia), during september 2021.

We used the Connor–Davidson Resilience Scale to assess resilience and the Perceived Stress Scale (PSS-10) to assess the level of stress. High scores indicate high resilience and perceived

The sample included 34 family caregivers of patients with mental illness. The mean age was 47.47 years (SD=12.4 years) and the sex ratio (M/F) was 1.42.

The mean resilience score of caregivers was 42.85 and the mean perceived stress score was 24.94 (SD=6.36).

The score of resilience correlated negatively with the score of perceived stress among family caregivers (r=-0.751 ; p=0.0001).

The Caregivers with low socioeconomic level were more likely to have a low resilience score (p=0.004) and to have high stress levels (p=0.04).

The level of perceived stress increased significantly in case of long duration of providing care (r=0.697 ; p= 0.001), the presence of stressful events (p=0.029) and the presence of agressive behaviors committed by patients (p= 0.001). However, the level of resilience decreased significantly in those same cases (p=0.001; p=0.002; p=0.0001 respectively)

Our findings suggest that high level of perceived stress among familiy caregivers impact negatively their capacity of resilience. So, interventions targeting stress related to stressful events and violence committed by patients in their family environment should be integrated to increase the caregivers’resilience.

None Declared

Relapse prevention is critical because psychopathology and functionality can worsen in patients with schizophrenia because the repeated episodes and we have strong evidence of antipsychotics efficacy for relapse prevention, but nonadherence rates in patients with schizophrenia are very high, even in comparison with other illness. The literature speaks of average rates of 42% in schizophrenia. For that, long-acting injectable antipsychotics (LAIs) are considered important treatment option, but they are underutilized (Taipale et al. Schizophrenia Bulletin 2017; 44, 1381–1387) (Garcia et al. J Clin Psychopharmacol 2016; 36(4)355-371).

There is extensive clinical trial evidence for the use of paliperidone palmitate 1-month (PP1M) and paliperidone palmitate 3-month (PP3M) formulations for maintaining treatment continuity and preventing relapses and risk of hospitalizations in patients with schizophrenia. (Najarian et al. Int J Neuropsychopharmacol 2022; 25(3) 238-251).

Paliperidone palmitate 6-month (PP6M) formulation is a presentation that provides a dosing interval of once every six months. It is the first and only antipsychotic to be administered twice a year.

The principal aim of this study was to evaluate the effectiveness, safety, and tolerability of the PP6M in people with non-acute schizophrenia in a naturalistic psychiatric outpatient setting

Sample: 22 patients diagnosed with schizophrenia (DSM 5 criteria) that started treatment with PP6M after being stabilized with PP1M (N:10) or PP3M (N:12) (the treatment dose was not changed in the four months before study inclusion)

The mean dose of PP6M was 822.727 mg

Bimonthly, the following evaluations were performed during a follow-up period of 4 months:

The Clinical Global Impression-Schizophrenia scale (CGI-SCH)

Treatment adherence, concomitant medication, adverse events and the number of hospitalizations and emergency visits

Efficacy values: Percentage of patients who remained free of admissions at the end of 4months of follow-up.

Other evaluation criteria: Percentage of patients who never visited the emergency department at the end of 4 months of follow-up, average change from baseline visit to the final evaluation as assessed by score obtained on the following scale: GSI-SCH, treatment adherence rate and tolerability.

The percentage of patients who remained free of admissions at the end of the 4 months was 100% and the percentage of patients who never visited the emergency department at the end of 4 months was 100 %

Mean variations from baseline scores at 4 months were: (-0.21 ±0.31) on the GCI-SCH.

The rate of adherence to treatment with PP6M after 4 months was 100%.

Tolerability was good. None of the patients experienced an adverse event.

In our study, we found that short-term treatment with paliperidone palmitate 6-month formulation is effective and well tolerated in clinical practice conditions

None Declared

Patients with psychosis are particularly more prone to relapse, emergency presentation and subsequent hospital admissions (1). Hospitalization is not only a stressful experience to patients and carers, but also a financial burden to the National Health Service (NHS). Inpatient and community-based mental health services represent 47% of the annual healthcare costs for patients with SMI in the UK (2). The COVID pandemic had profound effects on health care services including the shift to remote consultations (Telepsychiatry) using video and telephone consultations in outpatient clinics. This shift to tele psychiatry was considered a novel challenge to both service users and service providers. We studied the impact of this change in the delivery of care on the number of admissions in patients suffering from psychoses.

We aimed at examining the factors associated with higher rates of hospital admissions and the effect of telepsychiatry (changes due to COVID) on the rate of hospital admissions in patients with a psychotic illness.

We reviewed the care plans of forty patients with a diagnosis of a psychotic illness who were randomly selected from two specialist psychosis teams in Essex. We looked into a number of factors to identify their associations with the number of hospital admissions. Moreover, we compared patients who had changes in their care due to COVID-19 with those who received care as usual in terms of the number of admissions in the first year of the pandemic.

Patients who were under CTO or were receiving Clozapine had significantly higher total number of admissions compared to those who were not. The change in the type of care to telephone or video consultation during COVID-19 was associated with a lesser number of admissions during the first year of the pandemic.

Patients receiving clozapine have higher total number of admissions. This finding might be explained by the severity of illness in this patient group. It could also be linked to the re-initiation policy within EPUT that mandates inpatient initiation and re-initiation of clozapine even in the absence of relapse signs. The shift from classic face-to-face to telephone and video consultation has its well-known shortcomings. However, it does appear to be a suitable alternative to a group of patients that it was associated with lower rates of hospital admission during the height of the pandemic.

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To conclude, the factors that were associated with a higher number of admissions in patients with psychosis were under CTO or receiving treatment with Clozapine. Preliminary evidence showed that telepsychiatry is a suitable alternative to standard care during the COVID-19 pandemic.

None Declared

Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) is characterised by a distinctive pattern of erythematous and symmetrical rash over the gluteal and intertriginous regions after exposure to certain systemic medications. This is an uncommon condition which has been thought to be due to a Type IV delayed hypersensitivity reaction. Literature on clozapine-induced SDRIFE remains scarce, and reports of cross-reactivity among anti-psychotics are limited as well.

To present a clinical case of Clozapine-induced SDRIFE with cross-reactivity between Clozapine and Quetiapine.

We describe a case of a lady with Treatment Resistant Schizophrenia who developed erythematous lesions with desquamation over her skin fold regions and buttocks within two months of Clozapine initiation.

In our case, the lady was diagnosed with SDRIFE secondary to Clozapine. Clozapine was ceased, and the rashes resolved completely within a week. However, her psychiatric condition continued to worsened and she was trialed on Quetiapine. Unfortunately, she developed angioedema of the lips which necessitated a cessation of Quetiapine.

This case report illustrates the importance of recognising this rare condition, which can be readily treated by withdrawal of the culprit drug. Given that Clozapine and Quetiapine are structurally similar and fall under the class of Dibenzodiazepines, physicians should also be aware of the possibility of cross-reactivity among anti-psychotic medications leading to hypersensitive reactions.

None Declared

Auditory Hallucination(AH) is a core & one of the most common symptom seen in schizophrenia. A prevalence study found that 1yr prevalence of AHs is 70% among patients of schizophrenia. Most theories of AHs discuss biological & psychological factors in phenomenology of voices. There definitely is a role of biological & neuroanatomical basis for occurrence of psychotic phenomenon & AHs, however environment & sociocultural background play important role in their genesis. It has been observed that theme of AHs is usually same, repetitive & associated with past life experiences of patients. The Negative Life Experience(NLE) though not always have significant impact on patient’s psyche, may manifest sooner or later in mental illness. Although AHs may be comforting, helping to cope up with unacceptable unconscious conflict, most patients report them to be negative, distressing & affecting socio-occupational functioning, thus making it important to understand & treat them effectively. Often, AHs stays as a residual symptom with which patient has to deal throughout life. This study is an effort to bridge existing gaps for better understanding of AHs & hence, Schizophrenia. It aims to understand effect of NLE on AHs, & thereby contribute to aetiology & therapeutic services to reduce distress of patients.

This study aims to find presence of history of past NLE in patients with schizophrenia having AHs, find a correlation between NLE & the content of AHs & hence to establish the role of sociocultural factors in phenomenology of AH in patients with schizophrenia.

A longitudinal study of 30 patients diagnosed with Schizophrenia as per DSM-5 having AHs visiting Psychiatry Department of Government Hospital was carried out over a period of 2yrs. A quantitative study to find correlation between presence of NLE & AH in patients and a qualitative study by in-depth interview of 10 patients with help of semi-structured questionnaire to understand phenomenology by procedures of interpretative phenomenological analysis was carried out.

A positive statistically significant correlation between NLE & content of AH was found. Majority of patients experienced AHs based on NLE in past & heard voices related to it. Various themes such as Guilt, Fear, Inadequacy, Anger, Frustration surfaced during the qualitative study.

This study thus strengthens the holistic model where sociocultural factors with biological & psychological factors play a role in pathogenesis of AHs. Treatment weighing on addressing NLE & emotions attached to it may help in foreshortening recovery & deal with residual AHs. This can help in therapeutic management of distress in patients, relieve internal conflict within their psyche, where they would feel more understood and learn to live with persistent AHs.

None Declared

Although some studies have reported that case management (CM), when is compared with standard care, reduces the loss of contact with health services, the debate continues about its superiority over other treatment models.

To assess treatment adherence and reasons for treatment discontinuation, and the impact of the type of APs administration on it, for a group of patients with schizophrenia treated in a CMP or receiving standard treatment in mental health units (MHUs).

An observational, longitudinal study (ten-year follow-up) was conducted on 688 patients with severe schizophrenia (CGI-S ≥ 5). All the causes of the end of treatment were recorded, together with the AP medication prescribed and kind of regimes.

43.6% of the patients had discontinued treatment in MHUs and only 12.1% on the CMP (p < 0.0001). 27.6% of patients in MHUs were on long-acting injectables (LAIs), and 57.6 on the CMP (p < 0.001). Treatment discontinuation was closely linked to be on OAPs medication in both cases (p < 0.001).Table 1.Treatment discontinuation, hospital admissions and suicide attempts [N(%)]

Our findings show how specific strategies as programs with an integrated treatment and case-managed approach, increase adherence. Moreover, treating with LAI APs clearly contributes to the achievement of these results. The widespread implementation of comprehensive community programs with case management, and the use of LAI-APs, should be an effective choice for people with schizophrenia and clinical severity and impairment, and at high risk of treatment discontinuation.

None Declared

Schizophrenia is a chronic disease that deteriorates the functionality of patients, especially when raising a family and caring for children. We are interested in analyzing the characteristics of mothers and fathers diagnosed with schizophrenia and their degree of global activity when switching from oral treatments to injectable treatments.

1 To evaluate the quality of life and functional level of mothers with schizophrenia treated with quarterly paliperidone palmitate. 2. To compare the quality of life and functional level when switching from oral treatment to long-acting injectables.

Participants were 3 mothers and 3 fathers, 33-40 years old, with a diagnosis of schizophrenia in monotherapy who changed treatment with monthly paliperidone palmitate to quarterly paliperidone palmitate LD IM (525 mg/every 12 weeks). Retrospective data collection. QLS quality of life scale.

Six patients were included, caregivers of 1 child (80%), 2 children (20%) who met the inclusion criteria and completed the questionnaires. After its application and correction by means of non-parametric tests (N<30). During oral treatment, scores are observed in the QLS questionnaire of: intrapsychic functions mean 34.2, interpersonal relationships mean 19, instrumental role mean 8, daily activities mean 8. After 12 months of treatment with intramuscular paliperidone palmitate (injectable every 12 weeks ) scores were obtained: intrapsychic functions mean 36, interpersonal relationships mean 23, instrumental role mean 15, daily activities mean 11. A better functioning of the patients was observed in the instrumental categories and daily activities. As well as the patients referred better adherence to treatment.

In our experience, injectable long-acting Paliperidone Palmitate every 12 weeks is associated with the perception of a better quality of life in parents with schizophrenia and increases administration facilities as well as planning in their daily lives.

None Declared

Clinical case description.

A 44-year-old male, with paranoid schizophrenia, polydrug addict and IVDU since he was 14 years old. Live alone. He is brought by the Local Police for heteroaggressiveness when he was arrested for trespassing and resisting authority. He has presented 14 hospital admissions and therapeutic communities for detoxification since 2000.

1. To analyze the causes of abandonment of treatment

1. 1. Complete medical history

2. 2. Blood test with hormone profile

3. 3. PRAEQ Questionnaire

Absence of child psychopathology until the age of 6, at which time his parents separate and he becomes introverted, with solitary activities and distractions. On examination, the patient is restless. Psychotic contact. Delusional speech centered on ill-structured ideas of harm, persecution and grandiose, being difficult to explore due to lack of collaboration on the part of the patient, who only accepts treatment with aripiprazole 5 mg due to sexual dysfunction with the rest of the treatments.

During his admission, he has evolved from a very unstructured delusional theme and social isolation, with lax and tangential speech and refusal to take any treatment except aripiprazole, towards a cooperative, trusting attitude, with attenuation of his delusional ideation, with appropriate, organized and releasable. Treatment with IM aripiprazole is agreed upon for discharge.

Clinical judgement: Paranoid schizophrenia (F20.0)

With this case, we intend to remember that antipsychotics affect different spheres of the patient’s life that can hinder adherence to treatment, and that we often do not take into account. In this specific case, Abilify Maintena is useful because it does not cause sexual dysfunction, which facilitates treatment adherence and greater patient involvement, which gives us greater opportunities for social integration.

None Declared

Neurological soft signs (NSS) have long been described in schizophrenic patients. However, recent studies focusing on first-episode psychosis and at-risk mental states have brought up some aspects that may point to a neurodevelopmental underpinning of the disease.

We aimed to review the published literature concerning NSS and psychosis and critically analyze it in regard to how it may constitute a body of evidence favouring the neurodevelopmental hypothesis of schizophrenia.

We conducted a Pubmed ® research using the following terms “neurological soft signs”, “psychosis”, “psychotic” and “first-episode”.

The studies that have been carried out found a gradation of NSS scores that had its minimum values in healthy controls, intermediate scores in at-risk mental state individuals, and highest scores in first-episode psychosis. NSS correlate with various brain imaging anomalies, which indicates abnormal neurological function. Its scores also correlate with poorer cognitive performance and more prominent negative symptoms in the short- and long-term. Interestingly, patients who have psychotic episodes associated with cannabis use have lower NSS scores than all the other psychotic-illness diagnostic groups.

NSS might thus translate a neurological dysfunction that exists previous to the psychotic break and is a measure of one’s vulnerability to psychosis. These results point to the existence of two distinct groups: one that has high NSS scores and therefore a high genetic vulnerability, needing little contribution of environmental factors to manifest a psychotic episode; and another one with low NSS scores, a smaller genetic vulnerability and a greater role played by environmental influences.

None Declared

Disruption of cerebral thermal homeostasis accompanies various CNS diseases. Presumably, (neuro)inflammation and the changes of temperature heterogeneity of the cerebral cortex may be interrelated links in the pathogenesis of schizophrenia.

to study the association between the brain thermal balance indicators, inflammatory markers and clinical features of the disease in patients with schizophrenia during therapy.

37 patients aged 16 to 46 years with schizophrenia (F20, ICD-10) were examined. Clinical examination included psychometric assessment using PANSS, HDRS, and YMRS scales. Cortical temperature was determined by microwave radiometry. Temperature heterogeneity was assessed by calculating the Pearson correlation coefficient between temperature indicators in 9 symmetrical areas of the cerebral cortex. The activity of the proteolytic system of inflammation (ratio of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity) and the level of autoantibodies to S100B and MBP antigens were determined in patients’ blood.

Low temperature heterogeneity is related to an increase in the activity of the proteolytic system of inflammation and a good response to therapy in most patients. High temperature heterogeneity is associated with insufficient activity of the proteolytic system of inflammation and the development of autoimmune reactions, which is accompanied by a more severe course of the pathological process and, in most cases, treatment resistance.

The association between the features of the thermal balance of the brain and inflammatory markers confirms the hypothesis of their role in the pathogenesis of schizophrenia. Temperature heterogeneity of the brain can serve as a criterion for predicting of therapeutic response in patients with schizophrenia.

None Declared

Although clozapine is considered the most effective drug for Treatment Resistant Schizophrenia (TRS), only 40% of patients treated will meet clinical response. Literature reviews and meta-analytic data offer no definite conclusions about the most effective clozapine augmentation strategies. Nevertheless, it has been suggested that the lack of evidence should not discourage clinicians from trying out new strategies in individual patients. Brexpiprazole is a novel 5-HT and DA modulator antipsychotic that exhibits partial agonism to D2/D3 and 5HT1A receptors, antagonism to 5HT2A and α-1B/2C receptors and represents a promising new drug in the pharmacotherapy of schizophrenia for both acute and maintenance treatment. In current literature there is no evidence of experiences in brexpiprazole augmentation for clozapine resistant patients.

This case report describes a successful clinical experience of brexpiprazole augmentation in a complicated case of clozapine resistant paranoid schizophrenia with consistent negative symptoms, the clinical evolution and metabolic improvement consequent to this therapy combination.

In a 27 male TRS patient, sequentially treated with adequate doses of risperidone, cariprazine, aripiprazole and olanzapine monotherapy, prescribed for adequate time, clozapine treatment was started, with a gradual titration from 25 to 300 mg/day, without significant clinical response on both positive and negative symptoms. Successively was introduced fluoxetine, from 10 to 30 mg/day, with no relevant clinical improvement. After 2 months of pharmacological stabilization with clozapine and fluoxetine described dosages, brexpiprazole was introduced starting from 1 mg/day and rapidly increasing till 4 mg/day.

After 6 weeks of treatment, PANSS positive and negative subscales showed a significant decrease, respectively from 28 to 17 and from 42 to 20, while general psychopathology subscale decreased from 66 to 34. Negative sub-items with major improvement were those regarding blunted affect, emotional withdrawal, poor rapport, and passive/apathetic social withdrawal. Brexpiprazole augmentation also allowed to slowly decrease (in 6 months) clozapine dose till actual 150 mg/day, with a significant improvement in general tolerability and a slow decline in metabolic parameters (BMI from 36.5 to 30.3; fasting glucose from 112 to 92 mg/dL; total cholesterol from 248 to 182 mg/dL; total triglycerides from 392 to 198 mg/dL).

In this case report brexpiprazole augmentation in a clozapine resistant young schizophrenic patient was an effective strategy with significant symptoms improvement, in particular in PANSS general psychopathology and PANSS negative subscales. The consequent clozapine dose reduction contribute to the slow decrease in metabolic parameters considered.

None Declared

Long acting injectable antipsychotics (LAIA) have been an important therapeutic advance. Due to poor adherence, in some patients the only way to ensure the continuity of outpatient care is to anticipate the use of a 3-monthly or 6-monthly LAIA. There is already experience of alternative initiations with 6-monthly and 3-monthly paliperidone palmitate with with an excellent tolerability and efficacy profile, following the same alternative initiation regimen used in these clinical cases.

The aim of the present study is to describe the alternative initiations with 3-monthly paliperidone palmitate (PP3) and 6- monthly paliperidone palmitate (PP6) carried out at the brief hospitalization unit of psychiatry of Hospital Central de la Defensa Gómez Ulla, Centro Sanitario de Vida y de Esperanza

We report two clinical cases. With regard to two patients diagnosed with schizophrenia, with poor adherence to treatment previously prescribed with monthly LAIA, refusal to take oral medication and with serious behavioral changes due to psychotic relapses, the process of psychopathological stabilization is described with an alternative initiation of PP6 and PP3.

Both patients had a diagnosis of schizophrenia, being men of 32 and 28 years of age admitted to the brief hospitalization unit of psychiatry, who presented important behavioral alterations due to sensory-perceptive alterations and the delusional ideas they presented. Initially, psychopathological stability was achieved, remission of all symptoms, with oral paliperidone 12 mg in both patients. Subsequently, the alternative initiation scheme was followed, consisting of administering on the same day (day 1) 150 mg of 1-monthly paliperidone palmitate (PP1) together with 1000 mg of 6-monthly paliperidone palmitate in one of the patients, and in the other patient, on the same day (day 1) 150 mg of 1-monthly paliperidone palmitate and 525 mg of 3-monthly paliperidone palmitate. Both patients maintained psychopathological stability, allowing early hospital discharge and no decompensation occurring during the following 6 months of follow-up.

There is an important group of patients with severe mental disorder that could benefit from an alternative initiation with 3/6-monthly paliperidone palmitate, rather than the standard initiation with monthly paliperidone palmitate. We present two patients who have greatly benefited from an alternative initiation, with the structure of PP1 150 mg + PP3 525 mg (both administered on day 1) and PP1 150 mg + PP6 1000 mg (both administered on day 1). The use of these alternative starts with PP3 and PP6 may be an important clinical tool for less adherent patients. More studies are needed to confirm these results.

None Declared

Long-term schizophrenia, even in remission, is necessarily accompanied by residual symptoms that may be quite pronounced and may significantly affect many aspects of the patient’s life, requiring exploration of specific therapeutic approaches. The alleviation of residual symptoms is an important factor in the patient’s better adjustment.

Assessment and study clinical characteristics long-term schizophrenia.

Clinical, statistical, psychometric. A total of 90 patients, mean age 66,6±13,3 years, 26 males, 64 females were examined.

Negative symptoms were predominant in patients with long-term schizophrenia (17,8±6,7). It was represented by: abstract thinking disorders (2,8±1,0), stereotyped thinking (2,7±1,1), passive-apathetic social isolation (2,6±1,2), avolition (2,6±0,8), flattening of affect (2,5±0,8). It manifested as lack of expressiveness in facial expressions and gestures, deficit of communicative gestures as well as emotional indifference (2,4±1,1), limitation of contacts with people, and spontaneous and fluent speech impairments. Positive symptoms were rare, mainly represented by suspiciousness (2,2±1,2), sometimes rising to delirium (1,8±1,4). Conceptual disorganization was detected in 1,9±0,7. Agitation and aggression were generally not characteristic of those surveyed. Depression/anxiety was quite pronounced in patients with long-term schizophrenia. Depression (1,8±0,8) was represented by low mood, hopelessness and loss of social interests. Anxiety (2,9±1,2) was even more prominent and predominant amongst all symptoms.

The authors expanded our understanding of the clinical characteristics of residual symptoms of long-term schizophrenia to allow timely identification and provision of medical and rehabilitative care.

None Declared

The association of an addictive disorder (harmful use, abuse or dependence) with a schizophrenic disorder is the rule. Genetic vulnerability and social and economic factors are common to both disorders.

determine the impact of addictive behavior on patients suffering from schizophrenia.

A descriptive and analytical retrospective study of 150 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.

The average age of the patients was 39.8 ± 11.23 years with a predominance of the age group 36-45 years (38.4%). All of the patients were male. Three quarters of the patients (75.5%) were consumers of psychoactive substances (PSA): nearly three quarters (72.8%) were dependent on tobacco, more than a third (39.7%) were dependent on alcohol, more than a quarter (29.1%) dependent on cannabis and almost a quarter (26.5%) dependent on other SPAs. Criminal history, suicide attempts and hospitalization in psychiatry were significantly more frequent in patients who consumed SPA than those who did not consume (39.5% vs 8.1%; p=0.008, 17.5% vs 2.7%; p=0.02, 89.5 % vs 75.7%; p=0.03, respectively). Patients who consumed SPA had significantly more positive signs of schizophrenia (51.8% vs 10.8%; p=0.001) and were significantly less observant to treatment (55.3% vs 16.3%; p=0.001) than those who did not consume. Hetero-aggressiveness, self-aggressiveness and job change were significantly more frequent in patients with addictive behaviors than those without addiction (86.8% vs 48.7%; p=0.001, 23.7% vs 2.7%; p= 0.004, 14.9% vs 0%; p=0.015, respectively). Multivariate analysis revealed that criminal history, hetero-aggressiveness, predominant positive symptomatology and work stoppage were the factors independently associated with SPA consumption in patients with schizophrenia in our study (β=14.7 95% CI 3.23–67.01, p=0.001, β=0.099, 95% CI 0.03–0.31, p=0.001, β=7.18, 95% CI 2.09–24.67, p=0.002, β=5.24 95% CI 1.27–21.7; p=0.02, respectively).

According to our study, addictive comorbidities concern three quarters of our patients. They expose them to a higher risk of legal problems, hetero-aggressiveness, predominance of positive signs and instability at work. These results encourage the development of methods for early diagnostic identification of addictive behavior comorbid with schizophrenia as well as integrated care combining psychiatric and addictological care.

None Declared

Autism spectrum disorders (ASD) and psychotic disorders have historically considered to be related conditions with a long history of diagnostic confusion. Although DSM-III distinguishes ASD and Schizophrenia Spectrum Disorders as distinct clinical entities, they continue to share overlaps in their clinical symptom presentations leading to diagnostic challenges that may consequentially result in delayed treatment. Prompt diagnosis is crucial in the context of psychosis, where early intervention impacts recovery.

To present the diagnostic challenges encountered in distinguishing ASD from Psychosis.

We present a case report demonstrating the challenges of distinguishing ASD from Psychosis.

This is a case of a gentleman who initially presented to psychiatric services at 18 years old for conflicts with his mother related to his inflexibility to change. Further psychological evaluation revealed that he had a history of restricted social interaction with his peers, difficulties in non-verbal communications and identifying emotional states, stereotyped interests and obsessions that isolated him from his peers. He was diagnosed with ASD.

In subsequent presentations, there were symptoms of excessive preoccupation of his facial appearance, excessive concern over contracting HIV, obsessions with arranging objects in a particular order and avoiding words starting with the letter “S” out of fears of blasphemy. While these symptoms had qualities of cognitive inflexibility, they could not fully be explained by ASD. Additional diagnoses of Body Dysmorphic Disorder, Borderline Personality Disorder, Obsessive Compulsive Personality Disorder and At-Risk Mental State were considered.

A psychiatric admission was necessitated at 21 years old, when he presented with a 2-year history of repetitive banging of furniture in the middle of the night to communicate his frustrations towards his parents for their perceived acts of blasphemy. He also began to isolate himself, fearing that his parents would be able to look into his soul and reveal his sins. This paranoia towards his parents worsened to the point of urinating and defecating in his room to avoid his parents. His school performance declined as well.

A unifying diagnosis of psychosis was made. His previous diagnosis of ASD was challenged as a misdiagnosis, with the impression that he likely had attenuated psychotic symptoms in his adolescent years, disguised as autistic traits. The diagnosis of psychosis was confirmed when the patient’s symptoms were observed to respond to antipsychotic treatment.

This case report illustrates the challenges in distinguishing ASD from psychosis. A prior diagnosis of ASD may result in diagnostic overshadowing and subsequent delays in diagnosing psychosis. Further research in diagnostic tools would be helpful for diagnostic precision, thereby enabling prompt treatment for better recovery outcomes.

None Declared

Olanzapine (OLA) is a common first-prescribed antipsychotic and has shown favorable efficacy in acutely exacerbated patients with schizophrenia. The mixed receptor activity of OLA and its greater affinity for serotonin 5-HT2A rather than dopamine D2 receptors are similar to those of clozapine. Pharmacokinetically, OLA is metabolized mainly by hepatic cytochrome enzyme P450 1A2 (CYP1A2). Because risks of antipsychotic polypharmacy include increased drug-drug interactions, pharmacokinetic considerations are important for selection of antipsychotics to be combined. Due to its pharmacological characteristics, amisulpride (AMI), another atypical antipsychotic with proven efficacy, is a promising adjuvant agent of special interest. AMI is unlikely to interact with other drugs due to the low plasma protein binding and metabolism and does not affect the activity of the CYP system. Furthermore, AMI is highly selective for dopamine D2/D3 receptors; has minimal or no affinity for D1, D4, or D5 receptors. Despite the potential benefits of the combination of OLA and AMI, only a few open-label studies have been conducted, and no randomized clinical trial has been performed to date to examine the efficacy and tolerability of the combination. Hence, the goals of this study were to test the hypothesis that AMI augmentation would improve psychotic symptoms and be well tolerated in schizophrenic patients who showed poor response to OLA monotherapy.

The purpose of this study was to compare the efficacy and tolerability of continued olanzapine (OLA) versus amisulpride (AMI) augmentation in schizophrenic patients with poor response to OLA monotherapy.

The present 4-week, randomized, rater-blinded study included 25 patients with schizophrenia who were partially or completely unresponsive to treatment with OLA monotherapy. Eligible subjects were randomly assigned at a 1:1 ratio to continuation of OLA monotherapy (OLA group) or OLA with AMI augmentation (AMI group). Efficacy was primarily evaluated using the Positive and Negative Syndrome Scale (PANSS) at baseline and at 1, 2, and 4 weeks.

The changes in PANSS total score and PANSS-positive subscale score were significantly different (p < 0.05) between the OLA and AMI groups. The differences between the two groups in PANSS-negative subscale, PANSS-general subscale, Brief Psychiatric Rating Scale, and Clinical Global Impression-Severity (CGI-S) scale scores were not statistically significant.

AMI augmentation could be an effective strategy for patients with schizophrenia who show inadequate early response to OLA monotherapy.

W.-M. Bahk Grant / Research support from: Handok Pharmaceuticals, Seoul, Korea, Y. S. Woo: None Declared, S.-Y. Park: None Declared, B.-H. Yoon: None Declared, S.-M. Wang: None Declared, M.-D. Kim: None Declared

As social stress includes social isolation, urban living, trauma and many other stressful events but social stress in context of workplace or job stress includes different factors. As in the case of social stress present at job place can be identified as a stress that is caused by planned social isolation or lack of social support at workplace. Bullying behavior of colleagues of an employee might also add up to the social stress (Øverli & Sørensen, 2016). Job stress factors also involves harassment on the hand of boss that is most often described as yelling, shouting, insulting and behaving oddly in front of other colleagues. All these factors can be quite stressful for an employee and also comes under the umbrella of social stress. This type of stress, if prolonged and adds other factors can also cause increased risk of psychoses.

Following study has certain clear objectives mentioned subsequently:

1. To investigate the prevalence of stressful work environment in association with prodromal psychosis for public and private sector employees

2. To investigate the difference between male and female employees for association of work stress with prodromal psychosis.

In this Study cross sectional method will be used. The following two scales The Brief Work Stress Questionnaire to measure work stress and Prodromal Questionnaire, Brief Version (PQ-B) for measurement of prodromal psychosis will be used.

For this study a sample of 300 consisting of doctors, teachers and banking officials (100 each) will be included using convenient sampling technique. The data will be collected from different work occupations like government and private sector. Male and female sample will be collected equally.

The objective of the present study is therefore to inspect the symptoms of prodromal psychosis among employees belonging to different occupations. Further to explore its relationship with work stress and other social and clinical demographics. Reliability analysis was done using Cronbach’s Alpha. Internal consistency of instruments was measured by Cronbach’s Alpha. Descriptive statistics and Pearson Product Moment was also used to analyze frequencies, demographic variables percentage. Independent Sample T-test was also used for assessment of gender difference.

This research was conducted to check the prevalence of job stress and its relation to prodromal psychosis in private and government employees in different job occupations. Other objective of this study was to explore the gender differences of job stress and prodromal psychosis among different genders as well as in different civil and private job occupations.

None Declared

Acute urinary retention (AUR) is known to have major impact on the quality of life and sexuality of patients with benign prostatic hyperplasia (BPH). However, little is known about specific approachs that could reduce this impact. Tadalafil, an efficient medication in uncomplicated BPH, may be also useful in serious complications, especially the AUR.

The aim of this study is to assess the impact of Tadalafil on sexuality and quality of life in patients AUR related to BPH.

This is a randomized, double-blind clinical trial conducted in the Urology and Emergency Departments of Sahloul Teaching Hospital, between June 2020 and January 2022. Consenting men over the age of 45 who had an AUR complicating a BPH were included. Fifty three patients were enrolled and randomized into two groups: intervention group (n=29) in which patients received 5 mg/day of Tadalafil, and control group (n=24) in which patients received a comparable tablet of placebo. The evaluation focused on sexuality and quality of life. For theses purposes we used SF-36 short form and IIEF 15.

Socio-demographic characteristics were comparable between both groups. Sexuality assessed by IIEF 15 was significantly better in the intervention group (p=0.02). The four SF-36 domains were also significantly improved by Tadalafil: “Physical Function” (p=0.046), “Pain” (p=0.01), “General Health” (p=0.029) and “Health change” (p=0.02).

Sexuality and quality of life could be improved by Tadalafil in complicated BPH.

None Declared

Chronic renal failure is a public health issue. It leads to a degradation of physical integrity, hormonal disorders and a great psychological impact, which can lead to sexual disorders.

The aim of this study was to identify risk factors of sexual dysfunction in patients on dialysis and renal transplant patients.

This is a cross-sectional survey conducted in nephrology department of Sahloul teaching hospital (Sousse) and Fattouma Bourguiba teaching hospital (Monastir) over two-month period. Patients on dialysis and renal transplant patients were included. Sexuality was assessed by FSFI and IIEF 15

This study enrolled 137 patients (99 patients with chronic renal failure and 38 renal transplant patients). The incidence of erectile dysfunction of men on dialysis was 57% and was associated to a decrease in testosterone level (11%) and an increase in LH level (50%). Its main risk factors were age (p=0.000), the duration (p=0.009), the cardiovascular diseases (p=0.03), the anxiety (p=0.000), the depression (p=0.000) and the different aspects of erectile dysfunction (p=0.000. In women on dialysis, the most common sexual disorder noticed was sexual arousal disorder (78.8%).

In the transplant, erectile dysfunction was found in 18.2% of transplant men and was associated to age was a predictive factor (p=0.03). In women, orgasm and desire disorders were the most common (69%).

Renal transplantation improved erectile dysfunction in men with IIEF score rising from 14 to 27 (p=0.021). It also improved sexual life in women: increase of desire (p=0.042) and orgasm scores (p=0.034).

Sexual disorders remain common in patients on dialysis and with renal transplant. Their management requires a systematic screening to improve patients’ outcome

None Declared

Spinal cord injuries are known to have physical damage. They are often accompanied by urinary and fecal incontinence, disorders of tenderness, neuropathic pain and motor deficits. Therefore they have a serious impact on physical, mental and social health.

The objective of our work was to assess sexual function and quality of life in men with spinal cord injuries.

This is a cross-sectional study enrolling patients with spinal cord injuries followed at the physical medicine consultation and/or urology department of Sahloul teaching Hospital during the period from January 2016 to January 2018.

This study enrolled 21 patients. Mean age was 45.62 ±15.79 years. Thirteen patients were married, and nine had a primary school level of education. Thirteen patients worked as building workers. The cause of the spinal cord injury was traffic accident in 12 cases. The overall IIEF 15 was 15.57±7.46. Thirteen patients had erectile dysfunction which was rated severe in five patients. The average MSQ was 27.52 ± 26.32 with 10 patients very dissatisfied. The overall SF-36 score was 31.71± 26.16. We found a statistical correlation between quality of life impairment and sexuality impairment in almost all dimensions and especially impairment of physical activity (r²=+0.783 p<0.001) and impairment of perceived health.

The impairment of sexual function is a serious health problem in patients with spinal cord injury. It has a serious impact in the quality of life that justify specific interventions.

None Declared