A 20-year-old female presents with a progressive 3-month mutism, hyporexia (20kg weight loss), abulia, anhedonia, apathy, social isolation,seeking company of her parents even at night, bradypsychia, sialorrhea, psychomotor slowdown and hypomimia. She is hospitalized in the Psychiatric Brief Hospitalization Unit (PBHU).Her parents relate the beginning of this symptomatology to a breakup and gender violence,which the patient confirms during the interview by eye/cephalic movements and single words jotted down.

The objective of this study is to describe the evolution of the patient during her hospitalization in the PBHU of Salamanca and to look into the available bibliography about mutism related to stress and sialorrhea.

We carried out a follow-up of the hospitalization of the patient and a structured search in PubMed with the keywords “mutism”,“sialorrhea” and “stress” in the last 10 years in English,Spanish and French.

Few or no articles where found.Therefore, the articles about mutism and stress were analyzed, which focused mostly in selective mutism. Regarding fear,the response to cope with the threat(fight, flight, freeze) is mediated by the autonomic system. The “Polyvagal Theory” speaks about the vagus nerve participating in emotion regulation (social communication and mobilization). Dissociation, in this context,has adaptive and defensive purposes and its threshold can be reduced by repeated stress situations.Long-term alteration of the autonomic nervous system has been described in selective mutism.This malfunction can be related to an elevated production of saliva due to the activation of the parasympathetic in the salivary glands, causing sialorrhea in our patient.

The patient began treatment with sertraline 100mg and risperidone 2mg with the aim of its antidepressive and major tranquilizer effects, she also began individual and family psychotherapy, we assured her sleep and intakes and she began to progressively recover her speech and mobility,identifying a possible trigger for the symptomatology: a physical beating of gender violence after her breakup.

Dissociation and “freeze” response can be a maladaptative mechanism to fear.The malfunction of the autonomic nervous system can explain the disconnection,poor gaze,low facial and body expression and inability to speak.

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Prospective memory is a memory for actions to be performed in the future, such as composing an abstract for Congress. Various studies (see, for instance, Khan, A, 2020) showed that deficits in prospective memory are part of depressive cognitive deficits. This study is devoted to the prospective memory characteristics of migrants - students from Afghanistan who study at American University in Central Asia

The study’s objective was to test the hypothesis of the existing connections between PTSD and prospective memory.

One hundred and fifty students submitted informed consent for participation in the study, which the local IRB approved. Twenty-five had been diagnosed with PTSD; others also experienced traumatic stress but did not present the complete clinical picture of PTSD.

The research was quantitative; a variety of self-questioners were used, including the one Dr developed by Azzizudin Khan in 2021 (Khan and others, 2021) to measure traumatic stress level, depression, anxiety, and subjective perception of the prospective memory.

ANOVA and family of regression statistics helped to establish connections between several variables.

One hundred and fifty students submitted informed consent for participation in the study, which the local IRB approved. Twenty-five had been diagnosed with PTSD; others also experienced traumatic stress but did not present the complete clinical picture of PTSD. The research was quantitative; a variety of self-questioners were used, including the one Dr developed by Azzizudin Khan in 2021 (Khan and others, 2021) to measure traumatic stress level, depression, anxiety, and subjective perception of the prospective memory. ANOVA and family of regression statistics helped to establish connections between several variables.

The study’s preliminary results, which are still in progress, showed that the perceived level of traumatization predicts the perceived failure in prospective memory. However, there are also a lot of statistical outcomes which need to be analyzed. Among those are, for instance, the connection between depression and prospective memory and the connection between prospective memory and anxiety.

Prospective memory deficiency is a part of a traumatic cognitive deficit. More research is needed to investigate cognitive distortion in PTSD.

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In contexts of chronic crisis, such as wars, the population is affected by prolonged traumatic exposure. In this type of context, it is sometimes difficult to provide psychological support to work through the trauma because the environment is neither stable nor reassuring. It is about finding care devices that despite the complexity of the situation, manage to bring relief and improve the ability to manage negative emotions and stress.

The objective of the intervention was to relieve people in distress, to help them contain their reactions to moments of anxiety so that they are more available and calm in their daily lives. Since the intervention could not provide long-term treatment for the potential traumatic stress, due to the abuses still in progress, it aimed to prevent the appearance and installation of the symptoms.

A group protocol based on emotional stabilization exercises was offered to children and adults from communities affected by the fighting in the civil war in the Central African Republic in 2021. In addition to giving elements of psychoeducation, participants could practice exercises aimed at stabilizing emotions and managing stress.

People could benefit from this psychosocial support with daily frequency for four consecutive days. At the beginning and at the end of the care device, psychometric scales were administered in order to be able to measure the improvement in well-being (WHO5) the reduction in symptoms of anxiety and depression (HAD) as well as traumatic symptoms in adults (PCL -5) and children (CPTS-RI).

Between February and April 2021, 1,200 adults and 400 children were able to participate in the emotional stabilization device. 90% of the participants showed an improvement in well-being and a reduction in stress and axiety reactions. The participants particularly appreciated the exercises for the ease with which they could be reproduced in daily life and transmitted to other members of the family and the community. Despite the fact that exposure to stress remained significant and daily, they expressed the feeling of having regained some control, at least over their own emotions and reactions.

In situations of chronic stress, where psychic traumatic symptoms cannot be treated sustainably, this emotional stabilization protocol can be an effective option to regulate the emotional states of exposed people and give them tools to cope with anxiety.

Two important points to emphasize are also the fact that this device can reach a large part of the population without a lot of means and that it can be provided by non-professionals in mental health, if properly trained and constantly supervised by experts.

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Adverse childhood experiences (ACEs) and exposure to potentially traumatic events (PTEs) during military service are associated with mental health problems. However, knowledge about relative contributions of these factors to non-U.S women combat veterans’ posttraumatic sequalae is sparse.

To examine associations between ACEs, combat exposure, military sexual trauma (MST), potentially morally injurious events (PMIEs), posttraumatic stress disorder (PTSD) and complex PTSD symptoms among women veterans.

A volunteer sample of Israeli women combat veterans (n=885) and non-combat veterans (n=728) responded to self-report questionnaires in a cross-sectional design study.

Combat veterans reported more total average ACEs, were more likely to experience 3 or more ACEs and specific ACEs of physical abuse and emotional neglect, as compared to non-combat veterans. Combat veterans also reported higher levels of combat exposure, PMIEs, higher prevalence of MST and higher levels of PTSD symptoms, but not CPTSD symptoms, as compared to non-combat veterans. Importantly, ACEs, combat exposure, MST-assault and PMIEs of betrayal predicted PTSD symptoms, while only ACEs and PMIEs of betrayal predicted complex PTSD symptoms.

This study emphasized the relatively high exposure to PTEs and PTSD symptoms of women combat veterans as compared to non-combat veterans. Our findings also confirm prior studies demonstrating associations between ACEs, combat exposure, MST and mental health problems. Importantly, we demonstrated the unique contribution of betrayal based PMIEs and the differential associations of PTEs with PTSD and Complex PTSD symptoms among combat veterans.

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After the war in Bosnia-Herzegovina that lasted from 1992 to 1995, the populations gradually rebuilt their lives haunted by the spectrum of personal and collective painful souvenirs. Regarding the children who were born after the war, some mothers would rather not talk about it to protect their children from what they might be feeling while others would definetely share what they have experienced to protect their children. Because the intergenerational transmission of war trauma from mother to baby has been poorly explored among populations who recently lived in a warzone, we seeked to highlight the particularity of the interpersonal relations between the mother and her child in connection with maternal psychotrauma, by searching the factors of influence on the functioning of the dyad.

The main objective of this study is to determine and conceptualize the modes of transmission of trauma from the study of mother-baby interactions in a Bosnian environment, after the war in Bosnia-Herzegovina.

In 2003, 40 mothers and their babies aged 2 to 36 months living in Sarajevo were enrolled in the study. Among these mothers, 31 lived in or near the warzone and 9 were either displaced in other areas of the country or were refugees in foreign countries. We assessed the level of severity of post-traumatic stress disorder (PTSD) using the Clinician Administered PTSD Scale (Blake et al, 1998). In order to examine the quality of the mother-child dyads of mothers who lived through the war, we videorecorded a 10-minute free play of 23 dyads in their home environment. Then the interactions were coded using the National Institute of Child Health and Human Development observation grid by two independent raters.

The results showed that all mothers who lived through the war presented post-traumatic symptoms but only half of them showed a PTSD. Videotaped observations of mother-child interactions during playtimes revealed that their interactions are less linked to the mother’s PTSD than to the influence of PTSD on maternal attitudes and thereby extending to those of their infant. They are less sensitive to their children’s signals. They are also more intrusive and detached. Overall, they are more focused on themselves than on their child when they are interacting. As a result, their children are more focused on play and less actively engaged in communicating with their mothers.

The interactions between the mother and her child cover a set of relatively complex processes during which the two partners influence each other. When a mother lives through the war, she will pass on to her child an often painful life story. And thus, it is not only the content but also the way she transmits it that influences how the child receives the objects of the transmission.

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The human reaction to traumatic events is often marked by a dialectic alteration of two emotional states –a state characterized by intrusion, anxiety and hyperarousal, and a state of denial marked by dissociation and numbing. These two seemingly opposite states represent attempts to modulate stress, as gradual reduction of their intensity represents an adaptation to stress. Maladaptive reactions to trauma, however, reflect disrupted regulation capacities, manifested as persistent over-modulation or under-modulation of stress.

To demonstrate that these manifestations of disrupted regulation, as observed among individuals with posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) are also reflected in patterns of pain modulation.

Three studies using self-report questionnaires and psychophysical tests, assessing sensitivity to pain, as reflected by pain thresholds, and reactivity to suprathreshold noxious stimuli, as implicated in their rating

Study 1 Included 32 PTSD outpatients, 29 anxiety disorder outpatients, and 20 healthy controls. PTSD patients reported higher rates of chronic pain (83.3%) than anxiety patients (42.0%) and controls (5.0%). PTSD severity correlated with chronic pain severity (r = 0.61, p < 0.01). PTSD patients displayed a unique paradoxical pain profile, according to which their pain thresholds were significantly higher than those of the anxiety patients and controls (p < 0.01), but they perceived suprathreshold stimuli as being much more intense (p < 0.01).

Study 2 included 32 PTSD outpatients and 43 healthy controls. Findings replicated the paradoxical pain profile among PTSD patients. Pain thresholds were positively associated with dissociation level (b = 0.49; p < 0.05) and negatively associated with anxiety level (b = -0.63, p < 0.01). Pain ratings were positively associated with anxiety (b = 0.52, p < 0.05) and negatively related to dissociation levels (b = -.51, p < 0.05).

Study 3 included 46 women diagnosed with BPD and 47 healthy controls. Women with BPD reported higher levels of childhood trauma (p < 0.05) than the controls. They also demonstrated higher pain thresholds (p < 0.05). Among subjects with high levels of body dissociation, implicated by reduced body awareness, those with BPD demonstrated hyposensitivity to pain, manifested in higher pain thresholds, lower suprathreshold pain ratings, and pain evoked by higher temperature, than the controls. Among those with low levels of body dissociation, BPD subjects demonstrated increased reactivity to pain as manifested in higher pain ratings and pain evoked by lower temperature.

These findings demonstrate the association between over-modulation and under-modulation of stress and over-modulation and under-modulation of pain, respectively, among PTSD and BPD patients. These findings point to parallel processes of disrupted regulation among traumatized individuals.

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Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, and in the majority of patients persists into adulthood. There is a lack of data regarding the risks of ADHD medication during pregnancy and breastfeeding. While some women may be able to discontinue without adverse effects, others may experience significant functional impairment. Due to the rising number of ADHD medication prescribed to women at child-bearing age, it is important to determine which medications can be considered relatively safe in pregnancy and lactation.

We aim to review recent evidence on the risks of stimulant and non-stimulant treatment in pregnancy and lactation.

Literature review on the topic through PubMed and Google Scholar using the search terms: “ADHD”, “ADD” , “Pregnancy”, “Lactation OR breastfeeding”, “Stimulants”, “Methylphenidate OR Amphetamine OR lisdexamfetamine OR atomoxetine OR modafinil”. Only original research papers written in English were included.

We identified twelve studies investigating the use of ADHD medication in pregnancy and four studies regarding lactation. Most of the studies did not find an elevated risk for congenital malformations by treatment with methylphenidate or medical amphetamines during pregnancy. A report suggested a moderate risk for congenital defects in infants exposed to modafinil in utero. The teratogenic effects of atomoxetine and guanfacine have not been investigated. Regarding lactation, only case reports and case series were found. Methylphenidate seems to be safe, with little transfer into breast milk and no reported adverse effects for the baby. Amphetamines transfer into breast milk and reach relatively high concentrations, and although the overall risk for intoxication seems to be low it cannot be fully excluded.

Prescription of ADHD medication to pregnant and lactating women should be considered after an individual risk-benefit estimation. In severe cases, when medication cannot be discontinued, the overall risk for adverse outcomes seem to be relatively low. More higher quality studies are needed on the topic.

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Trazodone is an antidepressant that exerts its effect through serotonin reuptake inhibition and 5-HT2A and 5-HT2C receptor antagonism. Galactorrhea, as well as the increase in prolactin levels, have been seldom related to antidepressants. These adverse effects are more frequently observed with antipsychotic medication.

To present and discuss a case of Trazodone induced galactorrhea in a 24-year-old female patient diagnosed with a moderate depressive episode, without psychotic symptoms.

Clinical case description and literature review.

We present the case of a healthy 24-year-old woman, medicated with oral contraceptives, presented to a Psychiatry Consultation due to worsening depressive and anxious symptoms. Prolonged-release Trazodone was initiated with the indication to gradually titrate up to 300 mg/day. On the third day of treatment (at the time, at a dose of 75 mg/day), the patient began to experience breast pain and galactorrhea. On the seventh day, due to continuation of the complaints, she went to a Gynecology Consultation, having carried out an analytical study, in which a prolactinemia value was registered within the normal range (18 ng/mL). The possibility of pregnancy or continued intake of anabolizing steroids was excluded. The condition reversed upon discontinuation of the drug.

The endocrine and reproductive effects of antidepressants are uncommon and galactorrhea is only rarely mentioned as a possible adverse effect of this type of medication. The neurobiological mechanisms underlying this association are unclear. The existing literature points to the possibility that serotonergic antidepressants act by suppressing dopamine neurotransmission (by indirect inhibition of the tuberoinfundibular pathway), facilitating the release of prolactin and thus contributing to the increase in its levels. However, there are also case reports of antidepressant-induced galactorrhea in the presence of normal prolactin levels. In the present case, a state of euprolactinaemia was, in fact, verified. The findings reinforce the importance of carrying out more studies and on a larger scale, to better clarify the mechanisms underlying this association.

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In organic mental disorders in people who have undergone COVID-19, it has been established that the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation is superior in effectiveness to traditional therapy with an antipsychotic drug, antidepressant and anxiolytic. The inclusion of 3-hydroxypyridine succinate, hyperbaric oxygenation in the complex therapy of this pathology corrects the concentrations of adrenaline, norepinephrine, dopamine, serotonin in the peripheral blood of patients, eliminates hormonal status disorders and humoral immune responses.

The aim of the work was to optimize approaches to the treatment of hypothymic disorders in organic mental illness, to substantiate the complex use of periciazine in combination with paroxetine, diazepam, 3-hydroxypyridine succinate and hyperbaric oxygenation in patients who underwent COVID-19.

The object of the clinical study were patients with organic mental disorders who underwent COVID-19. To assess the condition, laboratory research methods were selected taking into account the etio- and pathogenesis of diseases: determining the level of catecholamines, some indicators of humoral immune responses, and the hormonal profile.

Table 2.3 - Nosological structure of patients included in the study

In patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.

In patients with organic mental disorders, occurring with hypothymic symptoms, compared with healthy donors, there is a complex of disorders in plasma concentrations of catecholamines. Traditional and, to a greater extent, combination therapy increase the levels of serotonin, dopamine, norepinephrine, both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.Complex therapy with periciazine, paroxetine, diazepam in combination with 3-hydroxypyridine succinate and HBO for organic mental disorders causes a more complete reduction of hypothymic disorders both in the group of patients who did not have COVID-19, and in those who underwent a new coronovirus infection.

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The evidence of an inflammatory status at onset of psychosis supports the adjunction of anti-inflammatory agent to antipsychotic (AP). Some negative results of these clinical trials lead us to wonder about the anti-inflammatory power of AP.

Would the action of associated anti-inflammatory agents be negligible compared to the anti-inflammatory potential of AP?

We conducted a prospective study. We included patients hospitalized for acute relapse of schizophrenia. They were all treated with Risperidone. We measured High sensitive C Reactive Protein (Hs CRP) at baseline and 8 weeks after.

We included 24 patients. Mean age was 34,5 +7,32 years with 75% of female. Mean age of onset of illness was 24,63 ±4,81 years and illness duration was 10,70 +6,42 years. After 8 weeks, PANSS scores decreased significantly from 79,13 +12,07 to 47,21 +8,41 and Hs CRP levels dropped by 1,55 +3,96 mg/l.

These results highlighted the anti-inflammatory action of Risperidone. Clinical trial should consider the proportion of anti-inflammatory agents action.

None Declared

Depressive patients often receive antipsyhotics as ad-on treatmnent due to different reasons. Rare side effect, but with high potential for chronicity is tadrive dyskinesia. Standart treatment of this incapacitating condition includes tetrabenasine, valbenasine (not available in Bulgaria), tiapride, and strategies with adding antipsychotics. In case of lack of medication or therapeutic failure we face therapeutic dilemma. Fluvoxamine, an SSRI and σ1-receptor agonist, has been shown in case studies to be beneficial, and this confirmed in this case.

Description of improvement of tardive dyskinesia in a patient suffering from depression after switching antidepressive therapy to fluvoxamine.

Study of a case of switching to fluvoxamine, based on review of relevant literature and own previous experience of treating other hypekinetic disorders – tics, with the same medicine.

A fifty-nine year old female patient suffering from long term depression received different antidepressants but also different mood stabilizers, anxiolitics and antipsyhotics (typical and atypical) as add-on treatment due to resistance, severe insomnia and anxiety, including even clozapine. Combination of paroxetine and clozapine resulted in improvement of sleep anxiety and tension, but with marked sedation as a side effect. Medications were successfully tapered off and replaced with trazodone and pregabaline. Soon however oral dyskinesia occurred. Patient developed hypersensitivity reaction when treated with tiapride. After switching antidepressant to fluvoxamine dyskinesia improved substantially.T

This case demonstrates the potential of fluvoxamine in treatment of tardive dyskinesia. This effect is most probably result of σ1-receptor agonism of fluvoxamine.

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Long-acting injectable antipsychotic (LAI) are an important and arguably under-utilized therapeutic option, particularly where medication adherence is a priority (Pilon et al. Clin Ther 2017; 39 1972-1985).

In recent years, meta-analytic reviews of depot medications concluded that this route of administration produced clinical advantages in terms of overall outcome, with lower probability of relapse, readmissions, shorter hospital admission time, mortality, and thus better long- term prognosis over other oral antipsychotics (Leucht et al. Schizophr Res 2011;127 83-92). Depot treatment is associated with lower overall medical expenditure (Taipal et al. Schizophr Bull 2018;17 1381- 1387).

To describe the evolution of people diagnosed with a psychotic disorder 6 months before and after the introduction of long-acting injectable antipsychotic (LAI) in the acute psychiatric unit of San Rafael Hospital (Spain) from January 1, 2018 to December 31, 2018.

Retrospective and prospective naturalistic study. Patients with a diagnosis of psychotic disorder who were admitted to the acute psychiatric unit in 2018 and who were introduced to LAI (paliperidone palmitate, aripiprazole, olanzapine pamoate or risperidone), are selected. Sociodemographic variables (sex, age, ethnicity, migratory status, marital status, occupation, cohabitation) and clinical variables (main and secondary diagnosis, comorbidity with drug use and history of poor adherence) are described. The number of emergency visits and hospital admissions before and after the introduction of LAI antipsychotic treatment is compared.

The sample was composed of 99 subjects. The mean age was 42.46 years (SD 13.439) and 67.7% were men. The socio-demographic profile was: european caucasian ethnicity (73.7%), non- migrant status (69.7%), single (67.7%), inactive (43.4%) and residing in the home of relatives (50.5%). 53.5% have a diagnosis of schizophrenia, followed by schizoaffective disorder (24.2%). 45.5% are diagnosed with any drug use disorder, the most frequent being cannabis (30.3%). 76.8% have a history of discontinuing oral treatment. There was a statistically significant decrease (p<0.0001) in number of emergency visits and hospital admissions after the introduction of LAI antipsychotic.

In the general linear multivariate before-after model, there were significant differences (p=0.002) in the number of admissions after long-term IM antipsychotic treatment. As for the comparison of the effects between the different LAIs, there are differences between them (p< 0.0001). Post-hoc analysis (Bonferroni) only showed differential significance for treatment with Paliperidone Palmitate (p<0.0001).

The use of LAI antipsychotic can reduce the number of emergency room visits and hospital admissions, in line with literature.

None Declared

Olanzapine is a second generation antipsychotic. Sedation and weight gain are common treatment side effects. However, other rare side effects such as peripheral edema are yet to be documented.

Our study aimed to describe the clinical presentation of edema in a patient taking Olanzapine.

Case report

We present the case of a 42 male patient hospitalized for a manic episode. He was put on Olanzapine at 10 mg a day. During the hospitalization, the patient exhibited profuse pitting edema on his lower limbs and a rapid weight gain. He presented no other physical sign such as a fever, cutaneous lesions or trouble walking. Thrombophlebitis and erysipelas were eliminated after an extensive physical exam, complete blood work and doppler ultrasound exam of both legs.

Olanzapine was discontinued and the patient was prescribed a 4-day course of loop diuretics. Complete resolution of symptoms was noted 5 days later.

Further research regarding the mechanism behind edema in patients taking second generation antipsychotics are needed. We recommend monitoring for edema with initiation and titration of Olanzapine treatment.

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The social defeat hypothesis (SDH) suggests that a chronic experience of social defeat increases the likelihood of the development of psychosis. The SDH indicates that a negative experience of exclusion leads to an increase in the baseline activity of the mesolimbic dopamine system (MDS), which in turn leads to the onset of psychosis. Social defeat models have previously been produced using animal models and preclinical literature; however, these theories have not fully been tested in human clinical samples. There have been studies implying changes in brain structure due to social defeat interactions; however, research evidence is varied.

This study aims to uncover whether exposure to SoDe has an impact on brain structure. Furthermore, we hope to understand if these changes are relevant to other mental health disorders.

698 (506 no SoDe, 191 SoDe) participants between the ages of 15-41 were recruited from the PRONIA-FP7 study. SoDe was measured from the self-reported questionnaires’ Bullying Scale’ and ‘The Everyday Discrimination Scale’. T1-weighted structural MRI data were processed; five 2 sample t-test analyses were carried out to compare the GMV differences in the entire sample and between the four groups.

The VBM analysis showed significant group interactions in the right thalamus proper when comparing participants who had experience SoDe to participants who had not experienced SoDe including all 4 groups along with left cerebral white matter differences. In the ROP subgroup, significant group interactions in the left cerebellum white matter were found along with right cerebral white matter, left cerebral white matter and right Thalamus proper.

The findings suggest that there are significant group interactions in thalamus and cerebral white matter. This is in keeping with some previous research suggesting volumetric changes in the thalamus due to stress and psychosis. Similarly for white matter there is some evidence suggesting differences due to SoDe and psychosis. However, there is a scarcity of research in this area with different research suggesting distinctive findings and therefore the evidence is inconclusive. In the ROP group analysis significant group interactions were present in the cerebellum due to SoDe experience. There is research suggesting the cerebellum’s role in multiple different aspects like social interaction, higher-order cognition, working memory, cognitive flexibility, and psychotic symptoms, with every research suggesting multiple different things the role of the cerebellum in SoDe in the ROP population is in question. Nonetheless this large-scale research presents some interesting novel finding and leads the way to a new area of research. Further analysis will explore the relationship between groups on markers of stress (CRP) and neuroinflammation as potential mediation of the environmental effects of SoDe.

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Home Treatment (HT) teams are among the better-studied options to reduce admission at the hospital, having been described as an alternative to hospitalization in patients with schizophrenia. There may be certain risk factors which has already been described such as living alone (Dean and Gadd, BMJ, 1990; 301, 1021–1023; Schnyder et al., Acta Psychiatr. Scand. 1999; 99, 179–187), lack of awareness of the illness, uncooperativeness (Cotton et al., BMC Psychiatry, 2007; 7, 52) and fewer visits carried out (Morgan et al., Aust. New Zeal. J. Psychiatry,2006; 40, 683–690) which together can negatively influence the possibility of conducting intensive home follow-up and, therefore, increase the likelihood of hospitalization.

To describe de relative contribution of several risk factors to patient hospitalization related to the possibility of conducting intensive home follow-up of patients diagnosed with Schizophrenia following home treatment. Second, to determine de risk of hospitalization related to the possibility of conducting intensive home follow-up according to the presence of one or more risk factors of patients diagnosed with Schizophrenia following home treatment.

All patients with schizophrenia who were visited by a home treatment team in Barcelona between January 2017 and December 2021 were included in the study. To assess whether there was an increased risk of hospitalization associated with factors such as living alone, uncooperativeness (PANSS G8 item >= 4) and ≤1 home visit, two bivariate logistic regression analyses were conducted. We studied these factors as independent variables to assess the relative contribution to the risk of hospitalization, and we studied if the presence of 1, 2, 3 or 4 of these risk factors as independent variables worsened the risk of hospitalization.

Uncooperativeness shows the highest contribution to the risk of hospitalization, followed by ≤ 1 home visit, lack of insight and living alone, all results reaching significance (p=0.000).

There is an increase in the risk of hospitalization depending of the presence of 1,2,3 or 4 of these risk factors (1 risk factor (Odds Ratio = 1.21), 2 risk factors (Odds Ratio = 5.28), 3 risk factors (Odds ratio = 13.53), 4 risk factors (Odds ratio = 29.18).

There are a number of factors directly related to the possibility of conducting intensive follow-up that appear relevant in the case of psychotic patients in acute crisis treated at home. This set of variables are the lack of awareness of the illness, lack of collaboration, living alone and the number of visits that have been made, all with statistically significant differences in our study. These factors together also greatly increase the risk of hospitalization, becoming almost 30 times more likely when these 4 factors are present.

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Schizophrenia is a severe and common psychiatric disorder characterized by disturbed brain development. Brain-derived neurotrophic factor (BDNF) mediates differentiation and survival of neurons as well as synaptic plasticity during the brain development. Several studies have shown decreased serum levels of BDNF in chronic, first episode, and drug naïve schizophrenia patients. Folate provides the substrate for intracellular methylation reactions that are essential to normal brain development and function. Abnormal folate metabolism has been implicated in schizophrenia. For example, reduced maternal folate intake associated with an increased risk for schizophrenia. Also, low blood levels of folate have been reported in patients with schizophrenia, and are associated with clinical manifestation especially in the negative symptom domain.

With this study, we want to know how BDNF levels at baseline in drug-naïve FEP are associated with folic acid.

Fifty drug-naïve FEP treated between April 2013 and July 2017 at the ETEP Program at Hospital del Mar were included. Inclusion criteria were: 1) age 18-35 years; 2) DSM-IV-TR criteria for brief psychotic disorder, schizophreniform disorder, schizophrenia or unspecified psychosis; 3) no previous history of severe neurological medical conditions or severe traumatic brain injury; 4) presumed IQ level > 80, and 5) no substance abuse or dependence disorders except for cannabis and/or nicotine use. All patients underwent an assessment at baseline including sociodemographic and clinical variables. Fasting blood samples were obtained before administering any medication at baseline and used to determine folic acid and BDNF levels.

In our drug-naïve FEP sample, folic acid levels showed a significative positive correlation with BDNF levels at baseline (r = 0.584; p = 0.003). Moreover, we did a lineal regression model that showed that the baseline variables that better predict BDNF levels were folic acid levels, and cannabis use.

Our results are consistent with the findings from some of previous studies that also shows that lower folic acid levels are associated with lower BNDF levels at baseline in drug-naïve FEP. Folate deficiency is associated with cerebrovascular and neurological diseases, and mood disorders. The importance of folate in the nervous system was initially demonstrated in studies that established a greatly increased risk of neurodevelopmental disorders in the offspring of folate-deficient pregnant women. In the adult, epidemiological studies have linked lack of folate to neurodegenerative and neuropsychiatric diseases. However, the mechanisms by which chronic folate deficiency adversely affects CNS function are incompletely understood. Some studies in animals models have hypothesized that folate deficiency in animals could be associated with pyramidal cell loss and reduced hippocampal BDNF.

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Psychotic disorders have a huge impact on social functioning, which is the ability to stablish and maintain social activities such as interpersonal relationships and self-care activities of daily living. Research data support that the early intervention in people who have experienced a first episode of psychosis (FEP) -based on a multidisciplinary treatment including both psychopharmacological and psychosocial treatments-, has a relevant role in a favorable evolution. AGES-Mind study is based on manualized psychotherapeutic interventions for people with first-psychosis episodes.

To describe the use of rehabilitation resources and social functioning in a group of people with FEP who were included in a psychotherapeutic group program versus a control group, at 12 and 24 months since the beginning of the intervention.

Longitudinal, analytical, observational, retrospective study on a cohort of 46 patients with first-episode psychosis within the last 5 years. 23 patients received group psychotherapy in the context of the AGES-Mind study and they were compared with 23 control patients who did not receive a group intervention (treatment as usual). Controls were matched by age, gender and time elapsed since the first episode of psychosis with those exposed to the intervention. Sociodemographic data, social functioning (self-care, social activities, social relationships, and behavior) and use of rehabilitation resources outcome variables were assessed.

Significant differences were found regarding participation in social activities in the intervention group versus control group at 24 months. No significant differences were found in other dimensions of social functioning or in the use of rehabilitation resources.

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Further studies with larger sample sizes are needed in order to determine if the participation in group therapy leads to an improvement in social functioning and use of rehabilitation resources for people who have experienced a first episode of psychosis.

None Declared

Machine learning (ML) approaches are a promising venue for identifying vocal markers of neuropsychiatric disorders, such as schizophrenia. While recent studies have shown that voice-based ML models can reliably predict diagnosis and clinical symptoms of schizophrenia, it is unclear to what extent such ML markers generalize to new speech samples collected using a different task or in a different language: the assessment of generalization performance is however crucial for testing their clinical applicability.

In this research, we systematically assessed the generalizability of ML models across contexts and languages relying on a large cross-linguistic dataset of audio recordings of patients with schizophrenia and controls.

We trained ML models of vocal markers of schizophrenia on a large cross-linguistic dataset of audio recordings of 231 patients with schizophrenia and 238 matched controls (>4.000 recordings in Danish, German, Mandarin and Japanese). We developed a rigorous pipeline to minimize overfitting, including cross-validated training set and Mixture of Experts (MoE) models. We tested the generalizability of the ML models on: (i) different participants, speaking the same language (hold-out test set); (ii) different participants, speaking a different language. Finally, we compared the predictive performance of: (i) models trained on a single language (e.g., Danish) (ii) MoE models, i.e., ensemble of models (experts) trained on a single language whose predictions are combined using a weighted sum (iii) multi-language models trained on multiple languages (e.g., Danish and German).

Model performance was comparable to state-of-the art findings (F1: 70%-80%) when trained and tested on participants speaking the same language (out-of-sample performance). Crucially, however, the ML models did not generalize well - showing a substantial decrease of performance (close to chance) - when trained in a language and tested on new languages (e.g., trained on Danish and tested on German). MoE and multi-language models showed a better increase of performance (F1: 55%-60%), but still far from those requested for achieving clinical applicability.

Our results show that the cross-linguistic generalizability of ML models of vocal markers of schizophrenia is very limited. This is an issue if our first goal is to translate these vocal markers into effective clinical applications. We argue that more emphasis needs to be placed on collecting large open datasets to test the generalizability of voice-based ML models, for example, across different speech tasks or across the heterogeneous clinical profiles that characterize schizophrenia spectrum disorder.

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Day-night changes in several molecules are studied as biomarkers of circadian rhytms (Morera-Fumero, A. L. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2017; 75 207-212). Circadian rhythmicity of the pituitary-thyroid axis has been proven in healthy individuals, with a Thyroid Stimulating Hormone (TSH) peak in serum around midnight and peaks during day hours (Bellastella, G. et al. Life 2021; 11(5), 426). A recent meta-analysis has reported differences in serum TSH levels between first-episode psychosis and multiple-episode schizophrenia (Misiak, B. et al. Progress in Neuro-Psychopharmacology and Biological Psychiatry 2021; 111, 110402). However, studies assessing quantitative circadian variations on TSH serum in schizophrenic patients are scant.

Comparing serum TSH levels at two different times of the day (12:00 and 24:00 hours) and the differences between the acute (hospital admission) and recovered phase (hospital discharge) of the disease.

Fourteen male patients (age 26,8±9,3 years) with the diagnosis of paranoid schizophrenia psychosis according to the DSM-IV partake in the study. Patients were admitted to the University Hospital of the Canary Islands psychiatric room because of acute relapse. Blood samples were taken in the first 24 h of admission and at 24 h. before discharge. All patients gave written consent to participate in the research study. Serum TSH was determined by ELISA methods. Paired sample t-tests were performed between TSH serum levels at admission and discharge at 12:00 and 24:00 hours. Statistical analyses were performed using IBM® SPSS® Statistics 25 software for MAC (IBM Corporation 1989, 2017).

There were statistical differences between the 12:00 h and the 24:00 h of the TSH serum levels at admission (12:00: 145,856±156,961vs. 00:00: 192,006± 122,757, p = 0.04); TSH discharge, (12:00: 134,483±72,882vs 00:00: 244,214±148,697, p = 0.002). There were no statistical differences between the 12:00 TSH levels at admission and discharge (145,856±156,961 vs. 134,483± 72,882, p = 0.66). The 24:00 h comparison of TSH levels neither elicited significant results (admission: 192,006±122,757 vs. discharge: 244,214± 148,697, p = 0.15).

Schizophrenic patients undergo TSH serum changes in a circadian pattern during the acute and stable phases of the disease; nevertheless, they experience smaller deviations during the acute phase. Higher levels of TSH were observed around midnight, as it happens in healthy individuals, with higher peaks during the stable phase compared to the acute one.

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In 2018, within the Horizon 2020 program, RECOVER-E project activities were initiated in Montenegro. During the years 2019 and 2020 Community mental health team (CMHT) within the Special Psychiatric Hospital Kotor was established. This team became responsible for management of treatment of a group of users with severe mental health illnesses, based on the principles of „Flexible Assertive Community Treatment (FACT – A Dutch model).

The main objective of this research was to establish whether there were substantial differences regarding the use of seclusions, restraints and forced medication during the hospital readmissions in the group of patients treated by the CMHT, compared to usual mental health care in Montenegro.

A sample of 202 users of mental health services from Kotor and surrounding municipalities were recruited. Patients were randomized into two similar-sized groups - intervention group, whose treatment was managed by the multidisciplinary CMHT, and control group where treatment as usual was continued (outpatient treatment without field work and hospital readmissions during the psychotic relapses).

To estimate and follow-up the frequency of application of coercive measures in this research, hospital documentation was used.

Patients in the intervention group had statistically significant less coercive intervention (such are mechanical restraining, seclusions, isolations and forced medication) during the study. There were no significant differences in the number of hospital days and readmission rates.

This study showed that CMHT care could reduce some of the coercive measures during the treatment of severe mental illnesses.

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