CHARGE syndrome is a genetic entity caused by mutations in the chromodomain helicase DNA-binding protein 7 gene (CHD7) at 8q12.1. There are pleiotropic signs among individuals with this disorder. Diagnosis is clinical using medical criteria. CHD7 gene mutations are usually found in 90% of affected patients.

The aim of this study was to report behavioral signs of CHARGE syndrome and their phenotype-genotype correlations.

Four Tunisian males from Sfax (Tunisia) with clinical features suggestive of CHARGE syndrome were examined at our genetic counselling at the medical University of Sfax. Assessment of facial dysmorphic and behavioral features, karyotyping using RHG banding and molecular screening of CHD7 mutations were performed. Molecular analysis was made using direct Sanger sequencing of the entire CHD7 gene.

Molecular genetic analysis revealed two deletions of the CHD7 gene at exon 3 for the first patient and at exon 8 for the second. The two genetic alterations were associated to retarded growth development and genital hypoplasia. Sensory impairments included for the first visual defects and for the second auditory and olfactory defects. Besides constant delayed psychomotor development, the two patients shared receptive and expressive communication disorders, anxiety, attention deficit, cognitive impairment and intellectual disability. There were no aggressive traits nor major autistic features. Learning disabilities were also present for the two patients.

The CHD7 gene controls the developmental pathways as a transcriptional regulator in the nucleoplasm through chromatin organization. Mutational alterations lead according to the affected domains, and the structure of the nonfunctional CHD7 protein, to the perturbation of the regulation of the developmental pathways’ genes expression. CHD7 is demonstrated as an important component of neurogenesis through two neuronal determination factors: Sox4 and Sox11. While nonsense, frameshift and missense mutations are most common, deletions and duplications are less frequent. Moreover, while exon 3 is commonly altered, mutations of exon 8, which is related to the CHD7 protein chromodomain, are very rare. Phenotype-genotype correlations according to the type of genomic alteration of CHD7 gene are rarely published, particularly concerning behavioral and psychological features of CHARGE association. Here, physical disorders of our two patients seem to be different but behavioral features seem to be common. Multidisciplinary care is thus required for CHARGE syndrome and molecular analysis must be indicated because the type of the genomic alterations may be a key step for a more accurate management of physical and behavioral disorders.

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Depression shows a moderate heritability of 37-42%, which can be up to 75% in severely depressed samples 75%. At the same time SNP-based heritability of depression in GWAS-s is around 8-9%. Heterogeneity of the depressive phenotype may contribute not only to the lack of understanding its genetic background but may also hinder the identification of novel targets. Thus clinically relevant intermediate endophenotypes are needed for. The affective temperaments in the Akiskal model may be considered high-risk states or subclinical manifestations of mood disorders. Considering their strong genetic and biological background, high heritability in family studies, and their temporal stability, they may prove to be relevant endophenotypes for depression.

The aim of the current study was to investigate the genetic determinants and heritability of affective temperaments based on a GWAS approach.

775 subjects aged between 18-60 years recruited in Budapest, Hungary provided genetic samples and completed questionnaires including the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego) scale. A genome-wide association analysis was performed with the five affective temperaments as outcome variables. Age, gender, the top 10 principal components of the genome, and the other 4 phenotype were added in the model as covariates. Summary statistics derived from the GWAS analyses were used to estimate the heritability, i.e. the genetic variance explained by the different affective temperaments. LD score regression using LDPred2 [4] was performed to estimate heritability from the beta values and effect size in case of all 5 affective temperament phenotypes.

rs3798978 showed a genome-wide significance (p=4.44x10-8) for anxious temperament, and several other variants showed suggestive significances for all five temperaments. The highest estimated heritability (h2 = 0.5224) was observed for the depressive temperament, and similarly high heritability was observed for the hyperthymic temperament (h2 = 0.4956). Anxious and cyclothymic temperaments showed almost the same heritability (cyclothymic h2 = 0.1651, anxious h2 = 0.1663), whereas for the irritable temperament, we got negative heritability estimation (h2 = -0.0567), which means that all of the phenotypic variance is explained by environmental factors.

Our analyses yielded remarkably high heritability values for depressive and hyperthymic temperaments explaining 52% and 50% of phenotypic variances. In contrast to the 8-9% SNP-based heritability in depression studies our findings suggest that these temperaments may be relevant endophenotypes for mood disorders.

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Mental Illness Stigma is a barrier in access to healthcare. Stigma also influences population health outcomes by worsening, undermining adequate processes. The healthcare professionals show several stigmatising behavirous and cognitions, which may impair the adequate provision of care of this population with mental illness.

We aimed to measure mental health stigma in healthcare professionals at a portuguese hospital center.

A cross-sectional study of health profissionals was performed using a survey that included socio-economic and job related questions, personal and familiar questions regarding mental health, and Attribution Questionnaire 27 (AQ-27), a translated and validated stigma questionnaire with nine stigma sub-scales (Responsability, Pity, Anger, Dangerousness, Fear, Help, Coercion, Segregation and Avoidance).

The sample included a total of 388 participants. The majority of the respondants were female (82,5%). The age ranged from 22 to 69 (mean = 40,05). According to the job place distribution, we found statistically significant differences in various stigma subscales among several healthcare settings within our center. The inpatient unit professionals showed lesser stigmatising attitudes in anger, coercion, segregation and avoidance domains; and higher stigmatising attitudes in pity and help domains. However, professionals who work at surgery room showed higher stigmatising attitudes in danger and fear, but lesser levels of help domains. We also found differences in five stigma subscales among various health professions. The study didn’t show differences in stigma domains regarding personal or professional contact with mental illness, neither academic studies in mental health.

Our findings suggest that workplace environment and profession may impact mental ilness stigma levels in healthcare professionals. We propose that future studies could be done to investigate methods to mitigate mental illness stigma, tailored to address different stigma domains in different workplace settings.

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Mental health problems such as stress, anxiety and depression have been described among medical students and are associated with poor academic and professional performance. That’s why having a satisfying quality of life (QoL) is one of the main sources of motivation for students for their future.

Our objectives were to assess the QoL of medical students and residents in Tunisia and to explore the influencing factors on this one.

This was a cross-sectional study among medical students and residents in Tunisia, all universities included, where they completed a questionnaire which comprised the WHOQOL-BREF instrument in its french version and several socio-demographics questions, in September 2022. Statistical analysis was performed by SPSS 26.0.

One hundred twenty-five medical students and residents were included in our study. The mean age was 26.10(±3.41) years and most of them were female (73%). Mean scores of the WHOQOL-BREF in the physical, psychological, social and environmental domains were 36.51 (±11.54), 45.22 (±15.71), 37.19 (±18.61) and 52.94 (±14.84), respectively. Students and residents had a relatively higher environmental mean score and a lower physical health mean score. The lowest mean score of the physical domain was observed in the 6th year students while the lowest mean scores of the psychological, social and environmental domains were observed in the medical students. Besides, we found a higher score of social and environmental domains in the residents group. In addition, we found a high correlation between psychological and environmental domains (p=0.000), psychological and social domains (p=0.021). We also found a correlation between age and social domain (p=0.034), in fact, the higher the age was the better the score of the social domain was. And finally we found a significant relationship between the environmental domain and the level of studies (p=0.05).

Physical health, psychological, social and environmental issues have an important impact on the QoL of our population and hence their future. Certain factors seem to be involved and have to be taken into consideration in order to improve QoL among medical students and residents.

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Compassion is expected to be a characteristic present in medical students, since it is a key element in subsequent professional practice (Blanco et al., 2021). However, during the degree, students go through various demands that can generate burnout syndrome (Amor et al., 2020) and as a consequence a decrease in compassion. In this sense, it is important to provide empirical evidence on the possible relationship between these two constructs, in order to generate support that allows the implementation of mental health promotion strategies.

Analyze the relationship between compassion and burnout syndrome in medical students.

This study was done through a cross-sectional study of correlational scope in 250 medical students. The Compassion Scales developed by Gilbert (Gilbert et al., 2017) were used; they assess three general factors (Self-compassion, Compassion for others, and Compassion from others), However, in this study, we used only the self-compassion and compassion for others scales.

The results revealed a statistically significant, positive correlation between personal accomplishment and self-compassion. In the case of emotional exhaustion and depersonalization, significant associations were also found with self-compassion and compassion for others, but of a negative magnitude (Table 1).

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It was concluded that the higher the levels of self-compassion of the medical students evaluated, the greater their personal fulfillment. On the other hand, the lower the levels of self-compassion and compassion for others, the higher levels of depersonalization and emotional exhaustion were found in medical students

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Survivors from Covid-19 are more prone to psychological distress due to their experience of illness, hospitalization, and severe conditions. Diseases can also affect patients’ quality of life. Nursing of these patients is not limited to hospitalized patients and paying attention to the mental health status and quality of life of patients is one of the roles and responsibilities of nurses. The aim of this study was to determine the relationship between mental health and quality of life of Covid-19 survivors in selected hospitals of Tehran University of Medical Sciences in 2021.

Due to the disturbance in mental health and the decrease in the quality of life of the survivors of this disease, the results of the research can be used for policy making and rehabilitation planning for those who have recovered from this disease. Also, considering that the covid-19 virus may remain for years and infect many people, supporting and controlling the physical and mental conditions of these people in the long term can help to increase the quality of life and improve their mental health.

This study is a cross-sectional study in which the mental health and quality of life of 276 survivors of Covid-19 who were hospitalized in three hospitals of Imam khomeini, Shariati and Baharloo between February 2020 and July 2020 were examined. Data were collected by using demographic and clinical information questionnaire, 12-item general health questionnaire and 36-item quality of life questionnaire. Data analysis was performed using SPSS16 software at a significance level of 0.05.

The results showed that the general health (mental health) score of the participants in this study one year after Covid-19 was equal to 6/26 ± 2/75 and 231 survivor of Covid-19 (83.7%) score more than 3 they had. Regarding quality of life, the results showed that the dimensions of energy and vitality, and general health, had the lowest scores with an average of 53.3 and 54.71 (out of 100 points), respectively.There is an inverse relationship between mental health and all aspects of quality of life, so that with the deterioration of mental health status in Covid-19 survivors, their quality of life score decreases.

The results of the study showed that the mental health status of a large percentage of Covid-19 survivors is impaired and there is also a significant and inverse relationship between the total score of mental health and dimensions of quality of life and their total score of quality of life. Paying attention to the mental health problems of Covid-19 survivors by health system staff, especially nurses, and choosing supportive strategies for them is one of the priorities that should be considered. Psychological support for these people can improve their mental health and indirectly increase their quality of life.

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Bipolar disorder is a common chronic illness with progressive intermittent. The new health policy, which advocates the deinstitutionalization of patient’s mental illnesses, caused, for a part, a transfer of the load of these patients from the specialized care services to natural caregivers, which can involve a great burden for family members as well as an altered quality of life, anxiety and depressive symptoms.

The aim of the study was to evaluate the rate of anxiety, depression and the repercussions on life quality in natural caregivers of patients with bipolar disorder.

This is a descriptive cross-sectional study that involved a group of 50 caregivers of patients with bipolar disorder treated at psychiatry department ‘A’ at Razi Hospital. We applied a questionnaire recording the different socio-demographic data. To determine the impact on the caregivers mental health and life quality we used the WHOQOL-brief (World Health Organization Quality Of Life-abbreviated version) and the HAD (Hospital Anxiety and Depression) Scale.

Our sample consisted of 32 women and 18 men. The mean age was 52.12 years with extremes ranging from 28 to 79 years. A majority were parents (60%), 18% spouses, 16% siblings and 6% descendants.

The repercussions of management of patients with bipolar disorder on the life and health of the caregivers were significant. Indeed, more than half of the caregivers (52%) (n=26) had a definite anxiety symptomatology on the Hospital Anxiety and Depression Scale (HAD). Twenty-two percent (n=11) presented definite depressive symptomatology and thirty percent (n=15) doubtful depressive symptomatology on this same scale. The most impaired domains on the World Health Organization Quality of Life Scale-version abbreviated (WHOQOL) were first: the environment domain with an average of 25.9 and second: the physical health domain with an average of 23.9.

Being a caregiver for a patient with bipolar disorder is associated with a great burden that can be the cause of anxiety-depressive complications and an alteration in the caregiver’s quality of life. It is important to assess this burden and its repercussions in order to preserve good family dynamics and ensure the proper functioning of the helping relationship and consequently improve the prognosis.

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Procrastination is a widely recognized phenomenon that can be defined as a tendency to delay important life activities and decisions. This seems to be a common issue among schoolchildren and students, however is not limited to those populations and may also be observed among other social groups. Research shows that the indices of the occurence of procrastination may reach even as much as 20-25% of the total population. However, the frequency of the phenomenon seems to be considerably higher among academic environment.

We sought to investigate the association between the phenomenon of procrastination and the individual’s resiliency, sense of coherence and the development of the identity.

A web-based questionnaire study was performed on a random sample of Polish students of various fields of study, aged 18-30 years. A 131-item questionnaire was built based on an original questionnaire and four standardized tools for the assessment of procrastination tendencies, resiliency, sense of coherence and the development of the identity (polish-Kwestionariusz Zwlekania-KZ), the Sense of Coherence Questionnaire-SOC-29, the Ego Resiliency Scale, The Dimensions of Identity Development Scale- DIDS).

This questionnaire study included 294 participants, median age 22 (IQR=21-24). Mature forms of identity development (meaning the commitment making (CM) and identification with commitment (IC)) correlated negatively with the occurence of procrastination (R=-0,186, p<0.005 for CM; R=-0.288, p<0.05 for IC). Ruminative exploration (RE) correlated positively with tendency to procrastinate (R=0.218, p<0.05). Procrastination correlated negatively with the resiliency evaluation (R=-0.229, p<0.05) and the optimal regulation(OR) assessment (R=-0.255, p<0.05). All the SOC-29 domains along with its total score correlated negatively with the tendency to procrastinate (p<0.05 for all).

Based on the conducted study, there seem to be measurable psychological benefits regarding the individual’s personal performance resulting from a proper psychoeducation in the field of procrastination.

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Prior literature establishes bidirectional associations between suicide and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, the context of mental health services utilization remains under-investigated. This analysis examined patterns of mental health services utilization in patients with SUDs and suicidality, identified associated risk factors, and evaluated the impact of patient engagement on subsequent mental health outcomes

See above.

Electronic health records (EHRs) derived from 7 health systems across New York City between 2010-2019 were analyzed. Suicidality was identified as any ICD-9/10 diagnosis of suicide attempt, suicidal ideation, or self-harm injury. SUDs were identified as any opioid, cannabis, cocaine, hallucinogen, inhalant, sedative/hypnotic/anxiolytic, amphetamine, or other substance abuse or dependence. Quasi-Poisson regression adjusted for age, gender, and chronic diseases was used to model associations between OUD exposure and the frequency of encounters and estimate the relative risk (RR) of significant covariates.

A total of 6977 adults with suicidality and any comorbid SUD were selected, including 2203 (31.6%) with a diagnosis of OUD and 4774 (68.4%) without a diagnosis of OUD. Most patients were male (54.8%) and aged between 25-64 years (79.3%). Many (61.3%) had over 3 chronic diseases, including depression (80.8%), hypertension (60.6%), anemia (43.0%), and hyperlipidemia (41.9%). Compared to patients with other SUDs, those with OUD had higher odds of self-harm injury [OR: 1.26 (95% CI: 1.13-1.41)], depressive disorders [1.47 (1.29-1.67)], anxiety disorders [1.65 (1.48-1.84)], psychotic disorders [1.23 (1.11-1.37)], personality disorders [1.30 (1.16-1.48)], and post-traumatic stress disorder [1.37 (1.20-1.57)]. Patients with OUD were more likely to utilize all-cause outpatient (RR: 1.16), emergency department (ED) (RR: 1.43), and inpatient (RR: 1.60) services (p<0.001). Among OUD patients, males were less likely to have outpatient visits (RR: 0.79) and inpatient hospitalizations (RR: 0.88), and older age was protective against ED admissions (RR range: 0.62-0.71). Additionally, individuals with OUD were more likely than those with other SUDs to have SUD-related encounters, as well as suicide-related ED admissions and inpatient hospitalizations (p<0.0001). Those who had more mental health outpatient visits were less likely to have suicide-related ED admissions (RR: 0.85), however this association was weaker among younger or male patients with comorbid OUD.

Among suicidal adults with comorbid SUDs, those with a diagnosis of OUD were more likely to utilize mental health services and have psychiatric comorbidity. Males and older adults were less likely to utilize services.

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Despite the well-recognized risk poor maternal mental health poses to early child development, it is still rarely addressed in global health programming, especially in humanitarian settings where access to health and mental health infrastructures may be limited. Recognizing the critical role of maternal psychosocial wellness in addressing the health and development of children in conflict, Action contre La Faim/Action Against Hunger (ACF) developed the Baby Friendly Spaces (BFS) program. BFS is a holistic, evidenced-based psychosocial support program that aims to enhance mothers’ wellbeing, internal resources, and child caring skills in order to create a buffer against the deleterious health and developmental impacts of conflict on children.

In Bangladesh, we sought to evaluate the effectiveness of a psychosocial support program for Rohingya refugee mothers and their malnourished children under two years old living in Cox’s Bazar’s camps.

For this study, we used a matched pair randomization, where ten BFS program sites were allocated to either continue providing services “as usual” or to an “enhanced BFS program” after re-training and providing continuous supportive supervision of the BFS staff throughout the trial period. 600 mothers and their children were enrolled in the study and attended psychosocial stimulation activities related to child care practices and care for women. Data were collected at baseline and 8-week follow-up. Primary outcomes included maternal distress and wellbeing, functioning, and coping. For implementation purpose, a survey was administered on confidence at work for all BFS staff and a fidelity observation assessment was conducted.

Relative to “as usual” sites, mothers in enhanced implementation sites reported greater reductions in distress (B=-.30) and improvement in wellbeing (B=.58). These differences were small, but marginally significant (p=.058; p=.038) with standard estimation; There was no significant difference between the two groups for daily functioning and coping. BFS providers in “enhanced BFS program” reported higher confidence in service delivery than their colleagues (p=.01). Fidelity varied widely across different components, with some very high and some very low adherence. There tended to be better adherence to procedures in group versus individual sessions and for some specific activities across domains, for enhanced versus standard BFS.

Findings highlight the value of innovative study approaches for real-world evidence generation. Small but feasible adjustments to implementation can both improve program delivery for maximizing impact. Consequently, low-intensity psychosocial support activities holds potential for reducing distress and improving subjective well-being of conflict affected mothers.

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Approximately one person commits suicide every 40 seconds, resulting in more than 800,000 deaths per year worldwide. Regarding this phenomenon, it is necessary to highlight how suicide rates increase markedly with age. These reach their highest figures in people aged 85 years or older, and this increase is very worrying in certain geographical areas. Although there is extensive literature on the risk factors that influence at the individual level, the same cannot be said when the problem is analyzed at the population level.

The study aims to review the entire Eurostat database, relating suicide data from different European countries to any possible variables that may influence suicide. In this pilot phase, certain socioeconomic variables were chosen based on criteria of suitability and availability of the information provided, selecting data from 2015, as it was the most recent year in which most countries reported their data on suicide in people over 85 years of age.

Firstly, a comparison was made of suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries (suicide rate in people over 85 years of age divided by the total rate in the country). Secondly, socioeconomic variables that may be more strongly related to suicide in this age group in these European countries were studied. After calculating the conditional suicide rate in people over 85 years of age with respect to the overall suicide rate in each country (Fig. 1), Spearman correlations were performed between the conditional rates and different demographic variables, economic variables, social variables, and health variables.

Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, several significant associations were found. Suicide in those over 85 years of age was associated with economic variables (social deprivation, economic impossibility to buy new clothes, impossibility to dedicate money for personal matters and Gini coefficient), demographic (old-age dependency ratio) and health (self-perceived health). After performing a multivariate regression with the variables that were significant in the Spearman correlation, included the variables “old-age dependency ratio (X1)” and “economic impossibility to buy new clothes (X2),” with a value of R-square = 0.612 and a value of p < 0.01.

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The conclusions suggest that of the different variables studied, the great majority in which an association has been found belong to the field of economics, specifically poverty and economic inequality, and demographics, highlighting the old-age dependency ratio. Furthermore, marked north/south differences can be observed in the different European countries.

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Donepezil is an acetylcholinesterase inhibitor approved by the Food and Drug Administration for the treatment of dementia in Alzheimer’s disease. While it is not curative for Alzheimer’s disease, donepezil has been shown to improve symptoms and slow disease progression; however, cases of rare psychiatric adverse effects, including hallucinations, mania, and increased confusion, have been reported. This report presents a case of donepezil-induced psychosis, which quickly resolved following cessation of the offending medication.

To illustrate a unique case of donepezil-induced psychosis

The patient is an 81-year-old male with a history of late-onset Alzheimer’s disease, mild depression, hypertension, hyperlipidemia, gastroesophageal reflux disease, and myocardial infarction. The patient was prescribed oral donepezil 10mg twice daily to manage his late-onset Alzheimer’s disease. Subsequently, he began developing persecutory delusions, increased agitation toward his family, and auditory hallucinations. His symptoms were worse at night after taking the donepezil, and he regularly requested to have a firearm for self-defense in the late hours of the night. His symptoms progressed for several weeks before his family brought him into the geriatric psychiatry clinic to address his psychosis. The family recognized that these new symptoms started shortly after the patient began taking donepezil and had already started decreasing the dose to half of what was originally prescribed.

This patient experienced symptom remission from psychosis immediately upon discontinuation of donepezil. The patient and his family reported significant improvement with no continuation of hallucinations or paranoia. There was also reported improvement in mood and irritability, and the patient appeared significantly better upon follow-up with geriatric psychiatry. Due to this immediate improvement, the suspected causative factor in the precipitation of psychosis in this patient is the anticholinesterase activity of the donepezil. Although the prescribing information of donepezil details inadequate data proving an association between donepezil and psychotic symptoms, two other published case reports (Yorston GA et al. J Psychopharmacol 2000;14:303-4, Pozzi FE et al. Case Rep Neurol 2022; 14:359-365), along with this one, provide evidence of a causal relationship between the two. The patient was switched to memantine therapy and has remained free of psychotic symptoms thus far.

This case demonstrates the caution required among clinicians when prescribing donepezil for the treatment of Alzheimer’s disease. There needs to be a more focused risk evaluation of potential psychiatric adverse effects in patients treated with donepezil.

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According to data from the National Statistical Office of the Republic of Korea, the number of suicides increased with increasing age, and the elderly over the age of 65 had a higher suicide success rate using lethal means.

Among mental disorders, depression is known to be the most associated with suicide, and suicidal thoughts help predict the risk of suicide. Dementia, depression, and sleep disorders, which are typical mental health problems of the elderly, require treatment, but only 10% of the elderly receive appropriate treatment at the right time.

The purpose of this study was to identify suicide risk factors among the community dwelling elderly and to reveal their correlations. In addition, the differences of suicide risk factors were analyzed in the cognitively impaired group and the cognitively normal group.

We investigated 20,127 elderly over aged 65, from January 2019 to December 2019. The participants were asked to complete questionnaires. Cognitive function, depression, anxiety, sleep disturbance, suicidal idea data was obtained by mini-mental status examination for dementia screening (MMSE-DS), short geriatric depression scale (SGDS), geriatric anxiety inventory (GAI), Athens insomnia scale (AIS), and scales for suicidal ideation (SSI). We used the Chi-squared test and logistic regression analysis for these data to examine the suicidal risk factors and to analyze the relationships. And differences in suicide risk factors according to cognitive function were also analyzed.

Age, cognitive function, depression, anxiety, and sleep disturbance were identified as risk factors for suicide among the community dwelling elderly. Depression was the factor that increase the risk of suicide the most, followed by anxiety, impaired cognitive function, sleep disturbance, the late elderly (85 years or older), and the middle aged elderly (75-84 years old). In addition, depression increased the risk of suicide by 1.86 times in the cognitively impaired group.

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Among community dwelling elderly, depression was the most contributing suicide risk factor. Prevention and treatment of depressive symptoms should be more active in the cognitively impaired group.

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The Capgras syndrome (CS), firstly described in 1899, is a delusional conviction that a person emotionally close has been replaced by an imposter or duplicate. It has been associated to primary psychiatric disturbances as well as neuropsychiatric syndromes. Its etiology and management have been debated throughout the years. We describe a case of a 75 years old male who was admitted to our psychiatric ward due to aggressiveness towards his spouse, believing she was an imposter.

In light of this case, we aim to discuss its etiology and review the association between the Capgras syndrome and neurodegenerative diseases.

Classically, CS was associated to psychotic illnesses such as schizophrenia, schizoaffective disorder and substance abuse. However, recent studies shed light on other possible etiologies, such as neurodegenerative and nonneurodegenerative diseases. In older ages, it has been associated to Alzheimer’s and, most commonly, Lewy body dementia subtype. Research also shows that other misidentification syndromes are frequently present in association with CS. Patients are more likely to be aggressive towards caregivers under these circumstances. Studies suggest there is a higher prevalence of right hemisphere lesions in CS, namely frontal and temporal lobes, that impair facial processing. Various brain circuits are being proposed as possible etiopathogenesis.

In this case, parkinsonian signs were observed in our patient, such as resting tremor, imbalance gait and rigidity. Those had not been described before his hospitalization. His family stated memory loss and difficulty in executive functions were present for at least a year. This patient had no previous psychiatric history. Brain CT scan showed cortical atrophy.

A neurodegenerative cause was assumed, and the patient was started on a cholinesterase inhibitor and on a second-generation antipsychotic. Improvement was observed.

This case is an example of the heterogenous etiology of the CS. It is important to consider different diagnosis, especially in older ages. More studies are needed to improve the knowledge on CS etiopathogenesis as well as the brains circuits involved. Psychopharmacology tackling theses syndromes is also a growing.

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The evolution of schizophrenia with age remains poorly studied. The prevalence of negative symptoms in elderly people with schizophrenia is even less described in the literature.

to evaluate the prevalence of remission of negative symptoms in the elderly and to study the sociodemographic and clinical variables associated with this remission.

The sample consisted of 83 subjects aged 55 years and over, followed at the psychiatry department "G" of the Razi hospital in Tunis and suffering from schizophrenia according to the DSM5 criteria. Global remission was defined as a score below 4 on the seven negative symptom items of the PANSS. A questionnaire was administered to each patient to collect epidemiological and anamnestic data.

59% of the sample showed remission of global negative symptoms. 84% and 60% were in remission on the emotional and cognitive subscales, respectively. The existence of remission was correlated with lower PANSS global score, more preserved cognitive functioning, later age of onset, more family and social support, and the absence of a concomitant somatic illness.

This study showed that measures to optimize treatment of positive symptoms and cognitive functioning may have an impact on negative symptoms. Similarly, quality of social network in later life impacts the level of negative symptoms.

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The relationship between mood disorders, particularly depression and cognitive impairment is complex. The symptoms of depression in the elderly include confusion, sleep alterations, low concentration, cognitive deficits, and somatic complaints that may are also present in dementia, with depression being often a prodrome.

The present study aimed at investigating the presence of cognitive disturbances in outpatients over 65 years of age consulting us for a mood episode, as well as to investigate the possible relationships between cognitive and depressive symptoms.

The study included 57 older patients attending the Psychiatric Clinic of Pisa, with a diagnosis of a major mood episode according to DSM-5 criteria. The psychometric scales included: Hamilton Depression Rating Scale (HAM-D), Beck Inventory Scale (BDI), Geriatric Depression Scale (GDS), to measure the severity of depression; Short Psychiatric Evaluation Schedule (SPES), to assess organic mental deficits; Cornell Scale for Depression in Dementia (CSDD), to assess depression in people with dementia; Adult Autism Subthreshold (AdAS) Spectrum, to evaluates the eventual presence of specific features of the autistic spectrum disorder(ASD). Moreover, patients were also assessed for cognitive screening with Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Mini-Mental State Examination (MMSE).

The HAM-D total score was 10.18±6.33, that of BDI 12.79± 9.89, that of GDS 12.69±8.25 and that of CSDD 8.35±6.25. The showed a MoCA value was 21.30±4.86, that of FAB 14.12±3.92, and that of MMSE 25.06±4.20. The MoCA total score positively correlated with those of the FAB and of the MMSE, while the FAB score with the MMSE score. A positive correlation was found between SPES and the HAM-D, BDI, CSDD and GDS total scores. The AdAS score positively correlated with that of MMSE. By correlating scores of depressive dimensions with those of cognitive functions, a positive correlation was noted between FAB total score and those of the HAM-D, BDI, CSDD and SPES

These findings suggest a possible link between the presence of ASD and depressive symptoms from the one side and cognitive performance and executive functions from the another side.

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Research has suggested an increased incidence of breast cancer in young women who have not yet completed family-building projects. However, the use of adjuvant therapies with cytotoxic drugs may affect fertility permanently or transiently. Furthermore, women undergoing prolonged adjuvant hormonal therapy have an increased risk of infertility due to the natural aging of the reproductive system during this period. Thus, young breast cancer survivors present fertility and childbearing concerns and related information needs.

The present study aimed to know the experiences of breast cancer survivors regarding the information received about reproductive health during cancer diagnosis and treatment and to identify unmet needs and preferences about how and when to receive this information.

A exploratory qualitative study was conducted using a convenience sample consisting of young women diagnosed with breast cancer aged 18 to 45 years. Semi‐structured interviews were carried out individually and online with 24 female Portuguese breast cancer survivors (M=37.21; DP=4.44) between June and August 2022.

From the preliminary thematic analysis of the data, three main themes were identified: 1) information received at the time of diagnosis; 2) unmet information needs, and 3) main preferences. Findings showed that most participants received information related to the impact of treatments on fertility, namely about the gonadotoxic effect of chemotherapy. This information was mostly provided by the nurses, but gaps were still identified. The interviews highlighted that, for most participants, it would be important to receive reproductive health information at an early stage of diagnosis, before treatment begins. Breast cancer survivors addressed the need to build a “uniform information model”, as well as booklets that systematize the reproductive impacts of cancer diseases, taking into account the specificities of each type of cancer and associated therapies.

Despite clear indications that fertility is an important issue in the context of breast cancer, the preliminary results of this study suggested that fertility counseling after diagnosis is still limited. There is a need to develop structured interventions that address the reproductive needs and concerns of these patients throughout the course of the disease.

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Mixed depression (MxD), is a nosologic entity characterized by the presence of excitatory symptoms during a depressive episode. MxD embeds high levels of chronicity, functional impairment and suicidality. The assessment of MxD in a subpopulation that features high levels of fragility, such as oncology patients, represent a pivotal strategy to reduce illness burden and suicidality in these subjects

The aim of the present project is to assess the characteristics of MxD in oncology outpatients and to compare them with those of outpatients without oncological comorbidity.

Forty-two oncology outpatients with MxD (ONC-MxD); 34 oncology outpatients and inhibited depression (ONC-inhib); 187 outpatients with MxD without oncological comorbidity (MxD); 224 outpatients with inhibited depression without oncological comorbidity (Inhib) and 168 healthy controls (HC) have been recruited. Analyses made include comparisons of demographic and clinical variables, depression severity, excitatory symptoms, suicidality and functional impairment.

Oncology outpatients with depressive disorder showed greater severity of depressive symptoms and greater functional impairment than those without oncological comorbidity (F=187.08; p<.001; F=54.08; p<.001, respectively). ONC-inhib showed greater inhibition than Inhib (p<.001), whereas no differences in levels of excitatory symptoms are present between MxD e ONC-MxD (p=.159). ONC-DMX have a more recent diagnosis of cancer than ONC-inib (F=13.39, p<.001) and higher rates of suicidal ideation (χ²=11.89; p=.008).

Cancer might worsen depression severity, especially in its inhibitory component. Relationships between onset of cancer, excitatory symptoms and suicidality suggest that the period following the diagnosis of cancer is the one at higher risk for suicide. Strategies aiming to treat excitatory symptoms in such period might help reduce risk of suicide in oncology patients.

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According to the WHO, breast cancer is the number one cancer in women worldwide, and its treatment can have serious effects on the bodies of young women. Surgical treatment can be disfiguring, and chemotherapy can cause an early and abrupt menopause. Each of these treatments can also affect a patient’s sexuality in the short or long term.

The aim of our study is to evaluate sexuality and body perception in women with breast cancer after treatment.

A quantitative descriptive study was carried out among 112 patients followed for breast cancer,majority in sexual activity, met at the consultation of gynecology of the hospital IBN ROCHD Casablanca, Morocco.The data collection was carried out by an information sheet and with the help of two validated scales: BIS (Body image scale) and FSFI (Female sexual function index) in order to evaluate body image and sexuality as well as the HADS (Hospital Anxiety and Depression Scale)

In our sample, 30.6% were older than 50 years, 40.2% were married, 52.2% of the patients came from urban areas, 20.7% of the patients were illiterate, 22.2%had given up their work due to the disease. In terms of family support, 49.4% of the patients were accompanied to the hospital, 52.8% received financial support and 43.8% received moral support.Regarding the relationship of the couple, there is an increase in the frequency of disputes in 49.5%of cases, a change in behavior in 44.9%. The sexual relationship was marked by a decrease in frequency in 36.7%. Concerning the type of treatment received by the 46.8% of the patients had a mastectomy, 20.9% had chemotherapy, 65.5% had radiotherapy and 45.5% had hormone therapy.The prevalence of depression was 54.1%. Its mean score on the HAD scale was 11.46±3.95; that of anxiety was 52.3% with a mean HAD of 11.41±4.04. The prevalence of sexual dysfunction was 100%with a mean FSFI of 14.26±3.68. Body image disturbance was noted in was noted in 83.8% of cases.The factors associated with a body image disorder in the univariate study were marital status (p =0.035; OR = 0.245), educational level (p =0.029; OR = 0.245), depression (p = 0.019; OR = 3.76), and anxiety (p = 0.029;OR = 3.44).

Multivariate analysis of predictors of body image disorder in women with breast cancer

In total, 4 factors were significantly associated. Given the importance of the subject and the harmful psychological impact on patients further rechearch is needed, also an adequate, emphasized training on the management of women with cancer and their sexual problems and a multidisciplinary work will help improve the psychological state of the women

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Anti N-methyl-d-aspartate receptor (anti-NMDA-R) encephalitis is a potentially reversible cause of psychosis. Nearly all patients (>95.5%) quickly develop additional neurological symptoms, and only about 50 percent fully recover, often with latency. At symptom onset, patients commonly present with isolated psychosis, making it challenging to distinguish the disease from a primary psychiatric disorder: The median time from symptom onset to immunotherapy in adults is 28 days (IQR 14–49), and from symptom onset to surgery in tumor-associated cases 1.4 months (IQR 0.7–2.6). Steroids, intravenous immunoglobulins (IVIG), or plasmapheresis are recommended as first-line immunotherapies.

To highlight a case with improved outcome after very early combined first-line immunotherapy (steroids plus IVIG) and surgery in tumor-associated anti-NMDA-R encephalitis.

Workup of the clinical case followed by a review of the literature.

We present the case of a 33-year-old woman with sudden onset of anxiety and jealousy ideas, which within a few days, developed a manifest psychosis with formal thought disorders, paranoid and guilt delusions, distrust, and orientation disorders in the absence of additional neurological deficits. A lower abdominal tumor suspicious of an ovarian tumor was detected sonographically five days before the onset of the first symptoms. Lumbar puncture and abdominal computer tomography were performed within 30 hours after hospital admission, confirming the diagnosis of tumor-associated anti-NMDA-R encephalitis with autoantibodies in CSF and serum at a very early clinical stage. First-line immunotherapy with steroids (methylprednisolone 1000mg, day 6 to 10 after symptom onset) was started immediately and combined with IVIG therapy (0.35g/kg, day 9 to 13 after symptom onset). Surgery of the ovarian tumor was performed on day 14 after admission, with histology revealing an immature teratoma. The neuropsychatric examination on day 1 after surgery showed complete remission of clinical symptoms, which persisted during clinical follow-up after 1 and 4 months.

The present case highlights the role of early CSF diagnostic and tumor assessment if autoimmune encephalitis is suspected. Very early first-line immunotherapy with steroids and IVIG, complemented by tumor surgery, was associated with improved outcome in this case with anti-NMDA-R encephalitis. Further studies are warranted to evaluate the generalizability of the finding.

None Declared